Gastrectomy for stage IV gastric cancer. a systematic review and meta-analysis

Gastrectomy as a primary treatment for patients with metastatic gastric cancer (M1) is highly controversial. Herein, a review of the literature was undertaken with the aim of assessing evidence regarding associated morbidity and mortality, overall survival, palliation and quality of life.

A systematic review of the literature from 1980 to 2013 was undertaken to identify relevant studies. Outcome data were pooled, and combined overall effect sizes were calculated using fixed or random effects models. The search identified 19 non-randomized studies reporting on 2,911 patients.

Overall postoperative mortality and morbidity were 14% and 27% and were higher in Western than in Asian patients. In studies published during the past decade postoperative mortality was less than 5%. The weighted 1- and 2-year overall survival rates were 38% and 17%, and were twice as high in Asian versus Western patients. In the meta-analysis, the 1-year overall survival was significantly higher in patients undergoing gastrectomy versus conservative (odds ratio (OR)=4.9, 95% confidence interval (CI)=3.2 to 7.5, p<0.0001) or gastrectomy versus non-resectional treatment (OR=2.6, 95% CI=1.7 to 4.3, p<0.0001). Studies reporting on quality of life and palliation indicate a possible benefit of such palliative gastrectomy.

A possible benefit of gastrectomy compared to non-resectional treatment for stage IV gastric cancer in terms of survival and palliation was evident but has to be cautiously interpreted due to potential sources of bias of retrospective non-randomized studies. Several questions regarding the optimal management of these patients remain unanswered and require a properly-designed randomized trial.