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Palliative Surgery for Patients with Gastroesophageal Junction or Gastric Cancer: A Report on Clinical Observational Outcomes

  • Gastrointestinal Oncology
  • Published:
Annals of Surgical Oncology Aims and scope Submit manuscript

Abstract

Background

Few studies have focused on palliative surgery in patients with advanced gastroesophageal junction (GEJ) or gastric cancer. We sought to evaluate clinical observational outcomes following palliative surgery in this population.

Patients and Methods

Patients with GEJ or gastric cancer who underwent palliative surgery (1/2010–11/2022) were identified. The primary outcomes were symptom improvement, ability to tolerate an oral diet, discharge to home, 30 “good days” without hospitalization, and receipt of systemic treatment. Postoperative outcomes and survival were secondarily evaluated.

Results

Among 93 patients, the median age was 59 (IQR 47–68) years, and the median Eastern Cooperative Oncology Group Performance Status (ECOG-PS) was 1 (range 0–3). The most frequent indication for palliative surgery was primary tumor obstruction [75 (81%) patients]. The most common procedures were feeding tube placement in 60 (65%) and intestinal bypass in 15 (16%) patients. A total of 75 (81%) patients experienced symptom improvement. Of these, 19 (25%) developed recurrent and 49 (65%) developed new symptoms. ECOG-PS was significantly associated with symptom-free time. Among those who underwent a bypass, resection, or ostomy creation for malignant obstruction, 16 (80%) tolerated an oral diet. Postoperatively, 87 (94%) were discharged home, 72 (77%) had 30 good days, and 64 (69%) received systemic treatment. Postoperative complications occurred in 35 (38%) patients, and 7 (8%) died within 30 days. The median survival time was 7.7 (95% CI 6.4–10.40) months.

Conclusions

Patients with incurable GEJ or gastric cancer can benefit from palliative surgery. Prognosis and performance status should inform goals-of-care discussions and patient selection for surgical palliation.

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Acknowledgement

We would like to thank Donald Norwood for reviewing and editing the manuscript.

Funding

This study was supported by the Holly Clegg Gastric Cancer Research Fund.

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Authors and Affiliations

  1. Department of Surgical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA

    Yun Song MD, Naruhiko Ikoma MD, MS, Paul F. Mansfield MD & Brian D. Badgwell MD

  2. John P. and Katherine G. McGovern Medical School at UT Health, Houston, TX, USA

    Eunise Chen BS

  3. Department of Palliative, Rehabilitation and Integrative Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX, USA

    Eduardo Bruera MD

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  1. Yun Song MD
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Correspondence to Brian D. Badgwell MD.

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Presentation: American College of Surgeons Clinical Congress 2023, 22–26 October 2023, Boston, MA.

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Song, Y., Chen, E., Ikoma, N. et al. Palliative Surgery for Patients with Gastroesophageal Junction or Gastric Cancer: A Report on Clinical Observational Outcomes. Ann Surg Oncol (2024). https://doi.org/10.1245/s10434-024-15416-4

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