Non-curative gastric resection for patients with stage 4 gastric cancer—a single center experience and current review of literature

• Published in: Langenbeck's archives of surgery Vol. 397; no. 5; pp. 745 - 753
• Main Authors: Dittmar, Yves, Rauchfuss, Falk, Goetz, Max, Jandt, Karin, Scheuerlein, Hubert, Heise, Michael, Settmacher, Utz
• Format: Journal Article
• Language: English
• Published: Berlin/Heidelberg Springer-Verlag 01-06-2012
• Subjects: Abdominal Surgery; Adult; Age Factors; Aged; Aged, 80 and over; Analysis of Variance; Cardiac Surgery; Cause of Death; Cohort Studies; Databases, Factual; Female; Gastrectomy - methods; Gastrectomy - mortality; General Surgery; Germany; Hospital Mortality - trends; Hospitals, University; Humans; Kaplan-Meier Estimate; Male; Medicine; Medicine & Public Health; Middle Aged; Neoplasm Invasiveness - pathology; Neoplasm Staging; Original Article; Postoperative Complications - mortality; Postoperative Complications - pathology; Proportional Hazards Models; Retrospective Studies; Risk Assessment; Stomach Neoplasms - drug therapy; Stomach Neoplasms - mortality; Stomach Neoplasms - pathology; Stomach Neoplasms - surgery; Survival Analysis; Thoracic Surgery; Time Factors; Traumatic Surgery; Treatment Failure; Vascular Surgery; Young Adult; Germany; Non-curative gastric resection; Chemotherapy; Survival; Gastric cancer
• ISSN: 1435-2443; 1435-2451
• DOI: 10.1007/s00423-012-0902-3

Purpose
The majority of patients with gastric cancer present with an advanced stage and, therefore, may not be eligible for curative treatment. The role of non-curative gastric resection in situations other than emergency treatment for life threatening tumor-related complications is still under discussion.
Methods
Data from 290 consecutive patients with advanced gastric cancer who were treated in our hospital were analyzed. A total of 48 patients underwent primary non-curative gastric resection.
Results
The overall survival in the non-curatively resected group was 15 months and 6 months for non-resected patients, respectively (
p
 < 0.001). The incidence of tumor-related complications which required intervention was 63% in non-resected patients as compared to 12% in patients who underwent primary non-curative resection. Younger age, less than three tumor locations, and chemotherapy have been identified as prognostic factors for improved survival by univariate analysis. D3 lymph node involvement and chemotherapy were independent prognostic factors in the multivariate analysis. Peritoneal carcinosis did not significantly influence survival in resected patients. Non-curative resection in combination with chemotherapy resulted in longer overall survival than resection alone.
Conclusions
Primary non-curative gastric resection can reduce the incidence of severe tumor-related complications and can prolong overall survival in selected subgroups. In particular, younger patients with no more than two tumor locations should be considered for this procedure.