Background: Surgery is effective as palliative procedure in esophagogastric cancer (EGC) patients in case of major symptoms such as bleeding or obstruction. In other malignancies (like colorectal, breast and kidney cancer), resection of the primary tumor seems to confer a better outcome even in presence of metastatic disease in pauci-or asymptomatic patients and randomized trials are ongoing.Material and methods: We retrospectively collected the clinical data of EGC patients treated from 2009 to 2014 at our Institution. Selection criteria were the following: histologically confirmed gastric or gastroesophageal junction adenocarcinoma, metastatic disease and treatment with at least one line of systemic chemotherapy. Primary end point was overall survival (OS) from the start of first-line chemotherapy, estimated using the Kaplan-Meier method. Two-tailed log-rank test was used for survival comparison between groups: statistical significance was set at p < 0.05.Results: We identified 148 patients eligible for analysis (gastroesophageal junction cancer: 26 patients; stomach cancer: 122 patients). Of these, 62 (42%) underwent primary tumor resection. There was no difference in terms of median OS between resected and not resected patients (10.4 and 10.7 months, respectively; p= 0.523, HR 1.13, 95%CI 0.779-1.630). The difference was not significant even when resected patients with synchronous metastases (i.e. with metastatic disease ab initio or developing distant metastases within 3 months after an apparently radical intervention) were compared with those who did not undergo surgery (median OS: 12.3 and 10.7 months, respectively; p = 0.596, HR 0.87, 95 CI 0.532-1.437). When the analysis was restricted to the 121 patients treated with doublet or triplet first-line chemotherapy, median OS did not differ between resected and not resected patients (11.9 and 10.7 months, respectively; p = 0.744, HR 0.93, 95%CI 0.608-1.426) and between resected patients with synchronous metastases and not resected patients (13.8 and 10.7 months, respectively; p = 0.458, HR 0.82, 95%CI 0.494-1.375).Conclusions: In the absence of impelling symptoms related to primary tumor, our analysis does not support the usefulness of palliative surgery in metastatic EGC patients treated with first-line chemotherapy. Background: Surgery is effective as palliative procedure in esophagogastric cancer (EGC) patients in case of major symptoms such as bleeding or obstruction. In other malignancies (like colorectal, breast and kidney cancer), resection of the primary tumor seems to confer a better outcome even in presence of metastatic disease in pauci-or asymptomatic patients and randomized trials are ongoing. Material and methods: We retrospectively collected the clinical data of EGC patients treated from 2009 to 2014 at our Institution. Selection criteria were the following: histologically confirmed gastric or gastroesophageal junction adenocarcinoma, metastatic disease and treatment with at least one line of systemic chemotherapy. Primary end point was overall survival (OS) from the start of first-line chemotherapy, estimated using the Kaplan-Meier method. Two-tailed log-rank test was used for survival comparison between groups: statistical significance was set at p < 0.05. Results: We identified 148 patients eligible for analysis (gastroesophageal junction cancer: 26 patients; stomach cancer: 122 patients). Of these, 62 (42%) underwent primary tumor resection. There was no difference in terms of median OS between resected and not resected patients (10.4 and 10.7 months, respectively; p= 0.523, HR 1.13, 95%CI 0.779-1.630). The difference was not significant even when resected patients with synchronous metastases (i.e. with metastatic disease ab initio or developing distant metastases within 3 months after an apparently radical intervention) were compared with those who did not undergo surgery (median OS: 12.3 and 10.7 months, respectively; p = 0.596, HR 0.87, 95 CI 0.532-1.437). When the analysis was restricted to the 121 patients treated with doublet or triplet first-line chemotherapy, median OS did not differ between resected and not resected patients (11.9 and 10.7 months, respectively; p = 0.744, HR 0.93, 95%CI 0.608-1.426) and between resected patients with synchronous metastases and not resected patients (13.8 and 10.7 months, respectively; p = 0.458, HR 0.82, 95%CI 0.494-1.375). Conclusions: In the absence of impelling symptoms related to primary tumor, our analysis does not support the usefulness of palliative surgery in metastatic EGC patients treated with first-line chemotherapy.