Effective palliation and quality of life outcomes in studies of surgery for advanced, non-curative gastric cancer: a systematic review

Mahar, Alyson; Coburn, Natalie; Karanicolas, Paul J.; Viola, Raymond; Helyer, Lucy

doi:10.1007/s10120-011-0070-0

Cited by 33 publications

(20 citation statements)

References 31 publications

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“…An accurate assessment of health‐related QoL using validated QoL measures is essential to inform clinical decision‐making. Unfortunately, there are few prospective studies using established QoL instruments to assess the impact of surgical palliation in patients with incurable advanced gastric cancer10, even though patient‐reported outcome measures are becoming increasingly important in an effort to give patients a better understanding of the treatment and care options available and outcomes, thereby facilitating decision‐making regarding care26.…”

Section: Discussionmentioning

confidence: 99%

“…Although some data exist on QoL associated with palliative chemotherapy for advanced gastric cancer6, 7, 8, QoL data associated with surgical palliation are sparse9 10. The aim of this study was to examine the impact of surgical palliation on postoperative QoL in patients with malignant gastric outlet obstruction caused by incurable advanced gastric cancer.…”

Section: Introductionmentioning

confidence: 99%

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Multicentre observational study of quality of life after surgical palliation of malignant gastric outlet obstruction for gastric cancer

Fujitani¹,

Ando

Sakamaki

et al. 2017

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BackgroundQuality of life (QoL) is a key component in decision‐making for surgical palliation, but QoL data in association with surgical palliation in advanced gastric cancer are scarce. The aim of this multicentre observational study was to examine the impact of surgical palliation on QoL in advanced gastric cancer.MethodsThe study included patients with gastric outlet obstruction caused by incurable advanced primary gastric cancer who had no oral intake or liquid intake only. Patients underwent palliative distal/total gastrectomy or bypass surgery at the physician's discretion. The primary endpoint was change in QoL assessed at baseline, 14 days, 1 month and 3 months following surgical palliation by means of the EuroQoL Five Dimensions (EQ‐5D™) questionnaire and the European Organisation for Research and Treatment of Cancer Quality of Life Questionnaire gastric cancer module (QLQ‐STO22). Secondary endpoints were postoperative improvement in oral intake and surgical complications.ResultsSome 104 patients (23 distal gastrectomy, 9 total gastrectomy, 70 gastrojejunostomy, 2 exploratory laparotomy) were enrolled from 35 institutions. The mean EQ‐5D™ utility index scores remained consistent, with a baseline score of 0·74 and the change from baseline within ± 0·05. Gastric‐specific symptoms showed statistically significant improvement from baseline. The majority of patients were able to eat solid food 2 weeks after surgery and tolerated it thereafter. The rate of overall morbidity of grade III or more according to the Clavien–Dindo classification was 9·6 per cent (10 patients) and the 30‐day postoperative mortality rate was 1·9 per cent (2 patients).ConclusionIn patients with gastric outlet obstruction caused by advanced gastric cancer, surgical palliation maintained QoL while improving solid food intake, with acceptable morbidity for at least the first 3 months after surgery. Registration number 000023494 (UMIN Clinical Trials Registry).

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Multicentre observational study of quality of life after surgical palliation of malignant gastric outlet obstruction for gastric cancer

Fujitani¹,

Ando

Sakamaki

et al. 2017

BJS Open

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“…Few of these studies reported information on changes in quality of life or symptom relief, which are the most appropriate primary outcomes in these patients. A detailed summary of quality of life and surgical palliation for surgically managed, advanced gastric cancer patients is reported elsewhere [78]. Procedure-related morbidity, mortality and long-term survival were more variable for patients in whom gastrectomy was not clearly performed for palliation of symptoms.…”

Section: Discussionmentioning

confidence: 99%

A systematic review of surgery for non-curative gastric cancer

et al. 2011

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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.

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“…Comparando la sobrevida de los 4 grupos de pacientes llama la atención que: a) se aprecia mayor pero no significativa sobrevida en pacientes con metástasis hepáticas solamente, comparados con los otros grupos y b) una mejor sobrevida en pacientes sometidos a gastrectomía total o subtotal que fue significativa. Este hecho ha sido publicado por varios autores extranjeros [14][15][16][17][18][19][20][21][22][23][24][25][26] . Se ha sugerido que el agregado de quimioterapia postoperatoria en pacientes con resección paliativa parece estar asociada a una mayor sobrevida que con la cirugía sola 19,22,23 .…”

Section: Discussionunclassified

Sobrevida De Pacientes Con Cáncer Gástrico Etapas Iiic Y Iv Sometidos a Cirugía: Parte Ii De Estudio Prospectivo 2004-2012

et al. 2014

Rev Chil Cir

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Survival of patients with advanced gastric cancer subjected to palliative surgery Background: Most patients with gastric cancer consult when the tumor is an advanced stage. Aim: To assess the survival of patients with gastric cancer in stage IIIc or IV subjected to surgery. Patients and Methods: Prospective study of patients with gastric cancer in stages IIIc (spreading to nearby organs or serosa) or IV (spreading to distant organs), who consulted between 2004 and 2012. A surgical exploration was carried out in all patients performing a palliative total or subtotal gastrectomy, a gastrojejunal anastomosis or only an exploration. Twenty five patients received adjuvant chemotherapy. All were followed until their death. Results: A surgical resection was performed in 61 patients (64%) with an operative mortality of 5 and 0% for total and subtotal gastrectomy, respectively. The mortality of non-resected patients was 6.4% with a maximal survival of 15 months after surgery. No significant differences in survival were observed between patients with hepatic or peritoneal metastases. Adjuvant chemotherapy significantly improved survival among patients subjected to gastric resection. Conclusions: Among patients with gastric cancer, palliative gastrectomy may improve quality of life and adjuvant chemotherapy apparently improves survival.

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Effective palliation and quality of life outcomes in studies of surgery for advanced, non-curative gastric cancer: a systematic review

Cited by 33 publications

References 31 publications

Multicentre observational study of quality of life after surgical palliation of malignant gastric outlet obstruction for gastric cancer

Multicentre observational study of quality of life after surgical palliation of malignant gastric outlet obstruction for gastric cancer

A systematic review of surgery for non-curative gastric cancer

Sobrevida De Pacientes Con Cáncer Gástrico Etapas Iiic Y Iv Sometidos a Cirugía: Parte Ii De Estudio Prospectivo 2004-2012

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