Abstract
Simple SummaryFor symptomatic stage IV gastric cancer involving major symptoms such as bleeding or obstruction, palliative surgery may be considered an option to relieve symptoms. Palliative gastrectomy or gastrojejunostomy is selected depending on the resectability of the primary tumor and/or surgical risk. However, treatment policies differ depending on the institution as to whether gastrectomy or gastrojejunostomy should be performed for symptomatic stage IV gastric cancer. We considered that gastrectomy might contribute more to prognosis than gastrojejunostomy for gastric cancer located in the middle or lower-third region where total gastrectomy can be avoided. Here, we compare the prognosis of gastrectomy and gastrojejunostomy for symptomatic stage IV gastric cancer. We demonstrate that distal gastrectomy for symptomatic stage IV gastric cancer located in the middle or lower-third regions contributes to prognosis with acceptable safety when compared to gastrojejunostomy.Background: The prognostic prolongation effect of reduction surgery for asymptomatic stage IV gastric cancer (GC) is unfavorable; however, its prognostic effect for symptomatic stage IV GC remains unclear. We aimed to compare the prognosis of gastrectomy and gastrojejunostomy for symptomatic stage IV GC. Methods: This multicenter retrospective study analyzed record-based data of patients undergoing palliative surgery for symptomatic stage IV GC in the middle or lower-third regions between January 2015 and December 2019. Patients were divided into distal gastrectomy and gastrojejunostomy groups. We compared clinicopathological features and outcomes after propensity score matching (PSM). Results: Among the 126 patients studied, 46 and 80 underwent distal gastrectomy and gastrojejunostomy, respectively. There was no difference in postoperative complications between the groups. Regarding prognostic factors, surgical procedures and postoperative chemotherapy were significantly different in multivariate analysis. Each group was further subdivided into groups with and without postoperative chemotherapy. After PSM, the data of 21 well-matched patients with postoperative chemotherapy and 8 without postoperative chemotherapy were evaluated. Overall survival was significantly longer in the distal gastrectomy group (p = 0.007 [group with postoperative chemotherapy], p = 0.02 [group without postoperative chemotherapy]). Conclusions: Distal gastrectomy for symptomatic stage IV GC contributes to prognosis with acceptable safety compared to gastrojejunostomy.
Highlights
Gastric cancer (GC) is one of the most common malignancies and the third leading cause of cancer-related deaths worldwide
126 symptomatic patients who underwent palliative surgery for stage IV gastric cancer (GC) were included in this study; 46 patients had undergone distal gastrectomy, and the remaining 80 patients underwent gastrojejunostomy
The operative time was shorter and blood loss was less in the gastrojejunostomy group, there were no significant differences in length of stay and postoperative complications between the groups
Summary
Gastric cancer (GC) is one of the most common malignancies and the third leading cause of cancer-related deaths worldwide. Treatment policies differ depending on the institution as to whether gastrectomy or gastrojejunostomy should be performed for symptomatic stage IV GC. A small number of retrospective studies have reported no survival benefits of gastrectomy compared to those of gastrojejunostomy for stage IV. We aimed to compare the prognosis of gastrectomy and gastrojejunostomy for symptomatic stage IV GC. Methods: This multicenter retrospective study analyzed record-based data of patients undergoing palliative surgery for symptomatic stage IV GC in the middle or lower-third regions between January 2015 and December 2019. Patients were divided into distal gastrectomy and gastrojejunostomy groups. Results: Among the 126 patients studied, 46 and 80 underwent distal gastrectomy and gastrojejunostomy, respectively. Surgical procedures and postoperative chemotherapy were significantly different in multivariate analysis. After PSM, the data of 21 well-matched patients with postoperative chemotherapy and 8 without postoperative chemotherapy were evaluated
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