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Is There a Role for Palliative Gastrectomy in Patients with Stage IV Gastric Cancer?

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Abstract

Patients with metastatic gastric cancer are currently not considered operative candidates and are most often offered systemic therapy. Palliative resection of the primary tumor has been considered irrelevant to the outcome and has been recommended only for palliation of symptoms. We have examined the role of palliative gastrectomy and its impact on survival in patients with stage IV gastric cancer at initial diagnosis between 1990 and 2000. A total of 105 patients with stage IV disease were identified during this period; 81 of them (77.1%) had no resection, and 24 (22.9%) underwent palliative gastric resection. Mean survival in those without resection who received chemotherapy (with or without radiation) treatment was 5.9 months (95% confidence interval 4.2–7.6). For those with resection and adjuvant therapy, mean survival time was 16.3 months (95% confidence interval 4.3–28.8 months). Kaplan-Meier survival analysis showed significantly better survival in those with resection and adjuvant therapy (log-rank test, P = 0.01). Mortality and morbidity rates associated with palliative resection were 8.7% and 33.3%, respectively, which did not differ statistically from the 3.7% and 25.3% in patients who underwent curative gastrectomy during same period of time. However, the length of hospitalization (22 versus 16 days) was significantly higher compared with those without stage IV disease. These data suggest that palliative resection combined with adjuvant therapy may improve survival in a selected group of patients with stage IV gastric cancer. Palliative gastrectomy plus systemic therapy should be compared with systemic therapy alone in a randomized trial.

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Acknowledgements

The authors thank Catherine Lobocki, M.S., for help in statistical analysis.

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Authors and Affiliations

  1. Providence Hospital and Medical Centers, 16001 West Nine Mile Road, Southfield, Michigan, 48075, USA

    Reza F. Saidi MD & Stephen G. ReMine MD

  2. University of Tennessee Medical Center, 1924 Alcoa Highway, Box U-11, Knoxville, Tennessee, 37920-6999, USA

    Paul S. Dudrick MD

  3. University of Kentucky, UK Healthcare, 800 Rose St. , Lexington, Kentucky, 40536, USA

    Nader N. Hanna MD

  4. Division of Surgical Oncology, University of Maryland, 22 S. Greene Street, Rm S4B33, Baltimore, MD, 21201, USA

    Nader N. Hanna MD

Authors
  1. Reza F. Saidi MD
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  2. Stephen G. ReMine MD
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  3. Paul S. Dudrick MD
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  4. Nader N. Hanna MD
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Saidi, R.F., ReMine, S.G., Dudrick, P.S. et al. Is There a Role for Palliative Gastrectomy in Patients with Stage IV Gastric Cancer?. World J. Surg. 30, 21–27 (2006). https://doi.org/10.1007/s00268-005-0129-3

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