Value of nonpalliative resection as a therapeutic and pre-emptive operation for metastatic gastric cancer

The value of nonpalliative resection in metastatic gastric cancer has not been clearly defined.

The survival and incidence of subsequent palliative interventions in 72 patients with metastatic gastric cancer who underwent nonpalliative resection were retrospectively compared with those of 56 patients that did not undergo resection.

The median survival of patients who underwent resection was greater than that of patients who did not (12.0 months versus 4.8 months; p = 0.000). However, more patients in the resection group had a good performance status, no neighboring organ invasion, and only one metastatic site, and this might have caused the survival difference. Adjuvant chemotherapy was the only independent predictor of survival after resection. Incidences of subsequent palliative procedures were not significantly different in the two study groups (43.1% in resection group versus 39.3% in the nonresection group; p = 0.668). However, the mean interval between operation and the first procedure was significantly different in the two groups (287.3 days in the resection group versus 164.1 days in the nonresection group; p = 0.032).

The survival of the patients that underwent nonpalliative resection was poor, and nonpalliative gastrectomy did not decrease requirements for subsequent palliative procedures. Only a few patients with a favorable response to adjuvant chemotherapy survived longer after resection and benefited from a longer symptom-free period until the subsequent palliative procedures were required. Nonpalliative resection should be reserved for selected patients based on performance status, resection feasibilities and metastatic tumor loads, and adjuvant chemotherapy should be combined as part of multimodality therapy.