Defining palliative surgery in patients receiving noncurative resections for gastric cancer

Effective palliation rather than cure is often the most appropriate goal in the management of patients with advanced gastric cancer. The literature to date is limited by the imprecise use of the term palliative and subsequent variable designation of patients into evaluable groups.

Between July 1985 and July 2001, 1,595 patients were entered into a prospective database after undergoing a resection for gastric adenocarcinoma. Patients who received a noncurative (R1/R2) resection were identified. A procedure was defined as palliative if it was performed explicitly to palliate symptoms or improve quality of life.

Three hundred seven patients received a noncurative gastric resection. The operation was palliative in 48% (147/307) and nonpalliative in 52% (160/307). Palliative operations included an esophageal anastomosis less frequently (46% versus 69%, p < 0.001) and had a less extensive lymphadenectomy performed compared with nonpalliative operations. Surgical intent did not alter operative morbidity (54%) or mortality (6%) significantly. The overall median survival after a noncurative gastric resection was 10.6 months and was independently associated with operations performed with explicit palliative indications (8.3 months [palliative] versus 13.5 months [nonpalliative], p < 0.001) and patient age > 65 years.

There are important differences among patients undergoing noncurative operations for gastric cancer. Studies designed to measure palliative interventions would benefit from precise designations of palliative intent in patients receiving noncurative operations.