Survival benefits of palliative gastric cancer resection - a regional center experience

In regions where screening programs are not widespread, the high number of patients with advanced gastric cancer remains a serious problem to the surgeon. Palliative resection remains debatable and has been considered irrelevant to the outcome. However, its role is widely accepted for palliation of symptoms and some series reported survival benefits.

Retrospective study including 155 patients with gastric cancer operated during 10 years. Clinicopathologic data, morbimortality and survival were registered and a detailed analysis performed for palliative cases.

This series included 90 curative and 40 palliative resections; 25 had other palliative procedures. 40.5% presented in stage IV. In palliative group, complications occurred in 22.5% after resection (vs. 16% in non-resection, p=0.524), with a lower postoperative mortality (7.5 vs. 24%, p=0.051). First year survival rate was better after palliative resection and in patients with locally advanced disease without distant metastasis it had a clear impact in the survival curve (log-rank test p=0.043). This benefit was not present on a long-term basis.

Palliative resections definitely improved short-term survival, without significantly increasing postoperative morbimortality. However, this was evident only for patients with locally advanced but not for metastatic disease. Multi-centric prospective trials are still missing.