Prognostic significance of palliative gastrectomy in incurable advanced gastric cancer: a retrospective cohort study and meta-analysis.

Abstract

There is controversy regarding the role of palliative gastrectomy in patients with incurable advanced gastric cancer requiring surgical intervention. The present retrospective cohort study and meta-analysis aimed to determine whether palliative gastrectomy plus chemotherapy can prolong the survival of patients with incurable advanced gastric cancer requiring surgical intervention. The data from 153 patients diagnosed with incurable advanced gastric cancer requiring surgical intervention at our institute between January 2000 and December 2012 were retrospectively reviewed. We analyzed the value of palliative gastrectomy and identified the potential prognostic factors. We also conducted a meta-analysis of 10 studies to validate our results. Multivariate analysis indicated that palliative gastrectomy was a favorable independent prognostic factor for prolonged overall survival in incurable advanced gastric cancer patients requiring surgical intervention (p=0.029). The median survival of patients who underwent palliative gastrectomy plus chemotherapy was significantly longer than that of those who underwent non-resection surgery plus chemotherapy (12 months vs. 9 months, p=0.020). The patients in the non-resection surgery plus chemotherapy group exhibited significantly shorter overall survival than those in the D1+ lymphadenectomy group, D2 lymphadenectomy group, or distal gastrectomy group (p=0.021, p=0.007, and p=0.006, respectively). Our meta-analysis revealed that gastrectomy plus chemotherapy improved long-term survival in incurable advanced gastric cancer patients (hazard ratio (HR): 0.48; 95% confidence interval (CI): 0.35-0.67; p<0.001). Palliative gastrectomy plus chemotherapy may improve overall patient survival compared with non-resection operations plus chemotherapy in incurable advanced gastric cancer patients requiring surgical intervention.