A systematic review of surgery for non-curative gastric cancer

Abstract

Background Most gastric cancer patients present with advanced stage disease precluding curative surgical treatment. These patients may be considered for palliative resection or bypass in the presence of major symptoms; however, the utility of surgery for non-curative, asymptomatic advanced disease is debated and the appropriate treatment strategy unclear. Purpose To evaluate the non-curative surgical literature to better understand the limitations and benefits of noncurative surgery for advanced gastric cancer.Methods A literature search for non-curative surgical interventions in gastric cancer was conducted using MEDLINE, EMBASE, and the Cochrane Central Register of Controlled Trials databases from 1 January 1985 to 1 December 2009. All abstracts were independently rated for relevance by a minimum of two reviewers. Outcomes of interest were procedure-related morbidity, mortality, and survival. Results Fifty-nine articles were included; the majority were retrospective, single institution case series. Definitions describing the treatment intent for gastrectomy were incomplete in most studies. Only five were truly performed with relief of symptoms as the primary indication for surgery, while the majority were considered non-curative or not otherwise specified. High rates of procedure-related morbidity and mortality were demonstrated for all surgeries across the majority of studies and treatment-intent categories. Median and 1-year survival were poor, and values ranged widely within surgical approaches and across studies. Conclusions A lack of transparent documentation of disease burden and symptoms limits the surgical literature in non-curative gastric cancer. Improved survival is not evident for all patients receiving non-curative gastrectomy. Further prospective research is required to determine the optimal intervention for palliative gastric cancer patients.

Prognostic factors in metastatic gastric cancer: results of a population-based, retrospective cohort study in Ontario

“…Although consistent, these results should be interpreted with caution. It has been well documented that treatment selection bias, or a lack of understanding of the decisionmaking behind receipt of a particular modality, likely confounds the association between treatment and survival [22]. Therefore, the treatment strategy a patient undergoes may be more a reflection of the patient's overall health and patient, physician and institution behaviors and preferences.…”

Staging and Surgical Approaches in Gastric Cancer: A Clinical Practice Guideline

“…In the systematic review by Mahar et al 43 , procedurerelated mortality was lower in palliative resections (0%-7%) than in either noncurative (0%-21%) or not-otherwisespecified surgeries (0% -20.4%). The mortality rate for gastrectomy performed for any intent was 0% -21%; the mortality rate for non-resection surgeries was 0%-39% 43 .…”

“…Morbidity ranged from 3.8% to 49% for gastrectomy and from 14% to 21% for non-resection surgeries 43 . In the literature update, procedure-related morbidity in moderatequality noncurative studies ranged from 15.1% 44 to 88.8% 45 for gastrectomy and from 11.5% 46 to 21% 47 for non-resection surgeries.…”

Regional Variation in the Management of Metastatic Gastric Cancer in Ontario

“…Patients with metastatic gastric cancer survive a median of 6 months after diagnosis 14 . We aimed to include all measures of resource utilization involved in both cancer-related care (for example, staging, treatment) and end-of-life care and palliation during the study's time horizon.…”

“…23.3123 alimentation 6,[9][10][11][12] . No clear guidelines for how to provide care for these patients exist, although the utility of invasive operations is debated in the literature 10,13,14 .…”