Abstract
Purpose
To investigate the value of palliative gastrectomy and chemotherapy in a large series of patients with stage IV gastric cancer.
Methods
A total of 389 patients were identified in survival analysis. Among which, 183 cases received palliative gastrectomy (PG) and 206 cases received unresectable operation, 184 cases received palliative chemotherapy (PC) and 205 cases did not receive chemotherapy. The survival advantages of patients, based on treatments modality, were also analyzed in patients with liver metastasis, peritoneal dissemination and lymph node metastasis.
Results
The 1-year, 3-year, 5-year survival rate of those patients who were treated with PG + PC were 85.7% (96/112), 32.1% (36/112), and 8.9% (10/112), which were far better than those who were not. For those patients with liver metastasis, peritoneal dissemination, and/or N3 lymph node metastasis, survival advantages were also present if treated with this multimodality approach.
Conclusion
The survival time and palliative duration were significantly longer in patients after PG than after non-resection operations. Postoperative chemotherapy prolonged the survival time of patients after palliative surgery. PG combined with adjuvant chemotherapy may improve survival in patients with stage IV gastric cancer, even with liver metastasis, peritoneal dissemination, and lymph node metastasis.
This is a preview of subscription content, log in via an institution to check access.
Similar content being viewed by others
Abbreviations
- PG:
-
Palliative gastrectomy
- PC:
-
Palliative chemotherapy
- UO:
-
Unresectable operation
- NC:
-
No chemotherapy
- DFS:
-
Disease-free survival
- OS:
-
Overall survival
Reference
AJCC (2003) Cancer staging manual, 6th edn, Springer, New York
Doglietto GB, Pacelli F, Caprino P, Alfieri S, Carriero C, Malerba M, Crucitti (1999) Palliative surgery for far-advanced gastric cancer: a retrospective study on 305 consecutive patients. Am Surg 65:352–355
Kakeji Y, Maehara Y, Tomoda M, Kabashima A, Ohmori M, Oda S, Ohno S, Sugimachi K (1998) Long-term survival of patients with stage IV gastric carcinoma. Cancer 82:2307–2311
Kodera Y, Yamamura Y, Shimizu Y, Torii A, Hirai T, Yasui K, Morimoto T, Kato T, Kito T (1997) Metastatic gastric lymph node rate is a significant prognostic factor for resectable stage IV stomach cancer. J Am Coll Surg 185:65–69
Lawrence W Jr, McNeer G (1958) The effectiveness of surgery for palliation of incurable gastric cancer. Cancer 11:28–32
Maehara Y, Moririguchi S, Kakeji S, Kohnoue S, Korenaga D, Haraguchi M, Sugimachi K (1991) Pertinent risk factors and gastric carcinoma with synchronous peritoneal dissemination or liver metastasis. Surgery 110:820–823
Medina-Franco H, Contreras-Saldivar A, Ramos-De La Medina A, Palacios-Sanchez P, Cortes-Gonzalez R, Ugarte JA (2004) Surgery for stage IV gastric cancer. Am J Surg 187:543–546
Miner TJ, Karpeh MS (2004) Gastrectomy for gastric cancer: defining critical elements of patient selection and outcome assessment. Surg Oncol Clin N Am 13:455–466
Miyazaki M, Itoh H, Nakagawa K, Ambiru S, Shimizu H, Togawa A, Shiobara M, Ohtuska M, Sasada K, Shimizu Y, Yoshioka S, Nakajima N, Suwa T, Kimura F (1997) Hepatic resection of liver metastases from gastric cancer. Am J Gastroenterol 62:490–493
Monson JR, Donohue JH, McIlrath DC, Farnell MB, Ilstrup DM (1991) Total gastrectomy for advanced cancer. A worthwhile palliative procedure. Cancer 68:1863–1868
Ohno S, Maeta M, Oka A, Hirooka Y, Baba H, Furusawa M (1994) Peritoneal dissemination after a curative gastrectomy in patients with undifferentiated adenocarcinoma of the stomach. Semin Surg Oncol 10:117–120
Otani S, Maeta M, Oka A, Hirooka Y, Tsujitani S, Ikeguchi M, Harnazoe R, Kaibara N (1995) Long-term survival of 5 years following initial surgery for gastric cancer and simultaneous disseminated peritoneal metastasis: report of a case. Surg Today 25:959–961
Ouchi K, Sugawara T, Ono H, Fujiya T, Kamiyama Y, Kakugawa Y, Mikuni J, Yamanami H (1998) Therapeutic significance of palliative operations for gastric cancer for survival and quality of life. J Surg Oncol 69:41–44
Parkin DM, Bray F, Ferlay J, Pisani P (2005) Global cancer statistics, 2002. CA Cancer J Clin 55:74–108
Sarela AI, Miner TJ, Jaques DP, Karpeh MS, Brennan MF (2004) Outcomes for patients with laparoscopically staged M1 gastric adenocarcinoma. Br J Surg 91:514–520
Sastre J, Garcia-Saenz JA, Diaz-Rubio E (2006) Chemotherapy for gastric cancer. World J Gastroenterol 12:204–213
Swan R, Miner TJ (2006) Current role of surgical therapy in gastric cancer. World J Gastroenterol 12:372–379
Takeno S, Noguchi T, Kikuchi R, Sato T, Uchida Y, Yokoyama S (2001) Analysis of the survival period in resectable stage IV gastric cancer. Ann Surg Oncol 8:215–221
Wang JY, Hsieh JS, Huang CJ, Huang YS, Huang TJ (1996) Clinicopathologic study of advanced gastric cancer without serosal invasion in young and old patients. J Surg Oncol 63:36–40
Wohrer SS, Raderer M, Hejna M (2004) Palliative chemotherapy for advanced gastric cancer. Ann Oncol 15:1585–1595
Yang L, Parkin DM, Ferlay J, Li L, Chen Y (2005) Estimates of cancer incidence in China for 2000 and projections for 2005. Cancer Epidemiol Biomarkers Prev 14:243–250
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Lin, SZ., Tong, HF., You, T. et al. Palliative gastrectomy and chemotherapy for stage IV gastric cancer. J Cancer Res Clin Oncol 134, 187–192 (2008). https://doi.org/10.1007/s00432-007-0268-z
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00432-007-0268-z