Role of palliative resection in patients with incurable advanced gastric cancer unfit for chemotherapy.

Abstract

114 Background: Recently, REGATTA trial showed that debulking surgeries followed by chemotherapy did not improve survival outcomes compared to chemotherapy alone for incurable advanced gastric cancer (AGC). Therefore, the standard treatment for incurable AGC without emergent symptom is not gastrectomy plus chemotherapy but chemotherapy alone. However, in patients who are unfit for chemotherapy due to poor performance status (PS), age, or comorbid chronic diseases, the role of palliative gastrectomy remains controversial. The aim of this study is to determine the role of palliative resection in patients with incurable AGC unfit for chemotherapy. Methods: Two hundred and twelve gastric cancer patients having any cause of incurable factors and underwent palliative gastrectomy or bypass operation between November 2002 and December 2014 were enrolled. Of these 212 patients, 64 patients who did not receive any chemotherapy were divided into two groups; Gastrectomy group with 45 patients who underwent palliative gastrectomy (distal gastrectomy in 18, total gastrectomy in 27) and Bypass group with 19 patients who underwent gastrojejunostomy. Survival outcomes and clinicopathologic features were compared between the two groups. Results: The reasons why unfit for chemotherapy were age (15), patients’ refusal (14), poor PS (11), postoperative complications (11), comorbidity (10), disease progression (3). There was no significant difference of clinicopathologic features between the two groups such as, age (MAN; 74.1 vs 77.1, p = 0.198), gender (male/female: 37/8 vs 13/6, p = 0.321), and number of incurable factors 2 or more (51.1% vs 63.2%, p = 0.422) except for postoperative complications of C-D grade 3 or more (24.4% vs 0%, p = 0.025). Median survival time of Gastrectomy group and Bypass group were 154 days (95%CI: 124-253) and 86 days (95%CI: 71-166), respectively, and significantly longer in Gastrectomy group (p = 0.002). Conclusions: These results suggest that palliative gastrectomy may improve survival in patients with incurable advanced gastric cancer unfit for chemotherapy.