Noncurative Gastrectomy for Gastric Adenocarcinoma Should only be Performed in Highly Selected Patients

Abstract

The benefit of surgical resection in patients with incurable gastric adenocarcinoma is controversial. A total of 289 patients who presented with advanced or metastatic gastric cancer from 1995 to 2010 were retrospectively reviewed. Ten patients (3.5%) required emergent surgery at presentation and were excluded from further analyses. Patients who underwent nonemergent surgery at presentation (n=110, 38.1%) received either gastric resection (group A, n=46, 42%) or surgery without resection (group B, n=64, 58%). Procedures in group A included distal gastrectomy (n=25, 54%), total gastrectomy (n=17, 37%), and proximal/esophagogastrectomy (n=4, 9%). Procedures in group B included laparoscopy (n=17, 27%), open exploration (n=25, 39%), gastrostomy and/or jejunostomy tube (n=12, 19%), and gastrojejunostomy (n=10, 16%). Group A required a stay in the intensive care unit or additional invasive procedure significantly more often than group B (15 vs. 2%, p=0.009). Four patients in group A (8.7%) and three patients in group B (4.7%) died within 30days of surgery (p=0.45). When the 110 patients who underwent nonemergent surgery (groups A and B) were compared to nonoperatively managed patients (group C, n=169, 58%), median overall survival did not significantly differ (8.6 vs. 9.2 vs. 7.7months; p>0.05). Three patients in group B (4.7%) and three in group C (1.8%) ultimately required an operation for their primary tumor. Patients with gastric adenocarcinoma who present with advanced or metastatic disease not amenable to curative resection infrequently require emergent surgery. Noncurative resection is associated with significant perioperative morbidity and mortality as well as limited overall survival, and should therefore be performed judiciously.