Peri-operative Outcomes and Survival Following Palliative Gastrectomy for Gastric Cancer: a Systematic Review and Meta-analysis

Joseph Cowling,Bethany Gorman,Pritam Singh,Sivesh K Kamarajah,Afrah Riaz,Richard P T Evans,James R Bundred,Ewen A Griffiths

doi:10.1007/s12029-020-00519-4

Abstract

BackgroundMany patients with gastric cancer present with late stage disease. Palliative gastrectomy remains a contentious intervention aiming to debulk tumour and prevent or treat complications such as gastric outlet obstruction, perforation and bleeding.MethodsWe conducted a systematic review of the literature for all papers describing palliative resections for gastric cancer and reporting peri-operative or survival outcomes. Data from peri-operative and survival outcomes were meta-analysed using random effects modelling. Survival data from patients undergoing palliative resections, non-resective surgery and palliative chemotherapy were also combined. This study was registered with the PROSPERO database (CRD42019159136).ResultsOne hundred and twenty-eight papers which included 58,675 patients contributed data. At 1 year, there was a significantly improved survival in patients who underwent palliative gastrectomy when compared to non-resectional surgery and no treatment. At 2 years following treatment, palliative gastrectomy was associated with significantly improved survival compared to chemotherapy only; however, there was no significant improvement in survival compared to patients who underwent non-resectional surgery after 1 year. Palliative resections were associated with higher rates of overall complications versus non-resectional surgery (OR 2.14; 95% CI, 1.34, 3.46; p < 0.001). However, palliative resections were associated with similar peri-operative mortality rates to non-resectional surgery.ConclusionPalliative gastrectomy is associated with a small improvement in survival at 1 year when compared to non-resectional surgery and chemotherapy. However, at 2 and 3 years following treatment, survival benefits are less clear. Any survival benefits come at the expense of increased major and overall complications.

Highlights

Primary gastric cancer (GC) is the fifth most common malignancy worldwide and frequently presents at a late and incurable stage [1]
Localised GC is often managed with combined resection and chemotherapy owing to a significant body of evidence which demonstrates its survival benefit compared to surgery alone [9–11]
Across studies containing a proportion of patients with metastatic disease, 9 studies of 93 included only patients with lymph node metastases, whilst 84 included patients with a mixture of metastases sites

Summary

Introduction

Primary gastric cancer (GC) is the fifth most common malignancy worldwide and frequently presents at a late and incurable stage [1]. The majority of patients present with either stage 3 or 4 disease and many will have already developed metastasis [2, 3] with many patients surviving less than a year after initial diagnosis [4, 5]. Progressive tumour growth means patients are at risk of tumour-related complications such as gastric outlet obstruction, perforation and bleeding, all of which can lead to reduced quality of life, emergency surgery and a reduction in life span. Many patients with gastric cancer present with late stage disease. Palliative gastrectomy remains a contentious intervention aiming to debulk tumour and prevent or treat complications such as gastric outlet obstruction, perforation and bleeding

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Results

Discussion

Conclusion