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

Abstract

Background This study was performed to investigate the role of surgery in patients with gastric cancer and distant metastases who had received systemic chemotherapy. Methods Patients with newly diagnosed gastric cancer and synchronous distant metastases who had received chemotherapy (n = 274) were categorized into 3 groups according to the surgical treatment rendered: complete gross resection of both primary and metastatic sites (group A; n = 42); debulking gastrectomy (group B; n = 47); and chemotherapy without debulking (group C; n = 185). Results The median overall survival of all patients was 11.8 months. The median overall survival and 3-year survival rates were 28.0, 15.5, and 9.0 months and 42.8, 8.1, and 3.5% in groups A, B, and C, respectively. In group A, patients with peritoneal seeding, intra-abdominal distant lymph nodes, or ovarian or hepatic metastases underwent complete gross resection, and 12 (29%) were disease-free at the time of the last analysis (median follow-up duration, 29.1 months). On multivariate analysis, the adjusted hazard ratios for death were 0.27 (P \ 0.001) and 0.64 (P = 0.024) for groups A and B, respectively, as compared to group C.Conclusions Our study suggests survival benefits of debulking gastrectomy or gastrectomy plus metastasectomy in gastric cancer patients with distant metastases receiving systemic chemotherapy. Prolonged disease-free survival was observed after complete resection (gastrectomy plus metastasectomy) that may lead to cure in some patients. Well-designed prospective trials of the role of multidisciplinary approaches combining chemotherapy and surgery are needed to confirm the observations of our study.

Clinical characteristics and prognostic analysis of Krukenberg tumor

“…In order to improve survival, there is a need to investigate the optimal management of Krukenberg tumors. For patients with gastric cancer, a Korean study suggested that debulking or gastrectomy plus metastasectomy may achieve survival benefits for patients with distant metastases who were receiving systemic chemotherapy (23). In our study, over two-thirds of the patients received chemotherapy.…”

Identification of prognostic factors and surgical indications for metastatic gastric cancer

“…Even in large volume centers, gastrectomy for metastatic gastric cancer has been reported to be associated with high rates of morbidity (>50%) and mortality (6–12%) [7,23]. Some recent studies [24,25] reported acceptable postoperative morbidity and mortality rates. In this study, severe postoperative morbidity was uncommon and there were no surgery-related perioperative deaths.…”

“…Although the role of metastasectomy is well established for colorectal cancer and sarcoma, there is still controversy regarding the usefulness of surgery targeting metastatic lesions in patients with gastric cancer, who have a reported median survival time of 11.2–31.0 months [24,26]. Some non-randomized comparative analyses suggested that aggressive surgical treatment of patients with metastatic gastric cancer prolongs survival.…”

Third international conference of the European Union Network of Excellence on gastric and esophagogastric junction cancer, Cologne, Germany, June 2012

“…Peritoneal carcinomatosis can be difficult to evaluate radiologically [8]. However it is recommended to use the Sugarbaker peritoneal cancer index (PCI) which describes 4 levels (Cotte).…”