Results following resection for stage IV gastric cancer; are better outcomes observed in selected patient subgroups?

Abstract

Long-term survival for patients with stage IV gastric cancer who are managed with surgical resection is achievable. Patient specific variables including East Asian race and age less than 60 years appear to be associated with prolonged survival when assessed by comparison of means, Kaplan-Meier analysis, and univariate regression analysis. However, multivariate regression analysis failed to demonstrate these factors as independent predictors of improved outcome. In conclusion, highly selected acceptable risk surgical candidates with stage IV gastric cancer should be considered for management with surgical resection in clinically appropriate scenarios.

Survival benefit of gastrectomy ± metastasectomy in patients with metastatic gastric cancer receiving chemotherapy

“…A recent meta-analysis of randomized trials that compared chemotherapy and best supportive care in patients with MGC revealed that chemotherapy was more beneficial than best supportive care alone with respect to OS and quality of life [20]. However, the role of surgery (debulking gastrectomy or gastrectomy plus metastasectomy) in GC patients with distant metastasis is still controversial [2][3][4][5][6][7][8][9][10][11][12][13][14][15][16][17][18]. The results of our study suggest that surgery may be beneficial in MGC patients when combined with chemotherapy.…”

“…Although systemic chemotherapy is the only proven standard treatment of MGC [19], most previous studies evaluating the benefit of gastrectomy ± metastasectomy in MGC were performed without considering the influence of chemotherapy. In most previous studies [3][4][5][6][8][9][10][11][12][13][14][15][16][17][18], both patients who had and had not received systemic chemotherapy were included. Therefore, many clinicians have been confused about the results, insisting on the benefits of surgery in stage IV (M 1 ) GC, based on results derived from heterogeneous patient populations.…”

“…GC mortality has remained high due to the frequent initial presentation with distant metastasis. Although surgery is mandatory for the cure of locoregional GC, the role of surgery for metastatic gastric cancer (MGC) is controversial [2][3][4][5][6][7][8][9][10][11][12][13][14][15][16][17][18]. For patients with MGC, palliative chemotherapy and best supportive care are considered the only standard treatment to achieve extension of survival and palliation of symptoms [19].…”

“…However, the role of metastasectomy is also controversial, as is that of debulking gastrectomy, because previous studies with small sample sizes have shown various outcomes, with a median OS of 11.2-31.0 months [4][5][6][7][8][9][10]. Moreover, most previous studies evaluating the benefit of gastrectomy ± metastasectomy in MGC were performed without considering the effect of systemic chemotherapy-the only proven standard treatment in MGC [19]-and thus both patients who had and had not received systemic chemotherapy were included [3][4][5][6][8][9][10][11][12][13][14][15][16][17][18]; this has made many clinicians confused about the real benefits of surgery in MGC.…”

Role of Surgery in the Management for Gastric Cancer with Synchronous Distant Metastases

“…These patients frequently undergo gastrectomy to reduce symptoms caused by advanced gastric cancer, including obstruction, abdominal pain due to perforation, and bleeding. Several studies reported that non-curative resection may also have survival benefits in gastric cancer patients with distant metastasis [1][2][3]. Other studies, however, found that non-curative gastrectomy had no survival benefits, but only increased postoperative morbidity and prolonged hospital stay [4][5][6][7][8].…”