Role of Palliative Resection in Patients with Incurable Advanced Gastric Cancer Who are Unfit for Chemotherapy

Hayato Omori, Yutaka Tanizawa, Rie Makuuchi, Tomoyuki Irino, Etsuro Bando, Taiichi Kawamura, Masanori Terashima

Research output: Contribution to journalArticle

Abstract

Background: The REGATTA trial showed that gastrectomy followed by chemotherapy for advanced gastric cancer with a single non-curable factor did not improve survival outcomes in comparison with chemotherapy alone. Chemotherapy is therefore the mainstay treatment for incurable gastric cancer. However, for patients who are unfit for chemotherapy, the role of palliative gastrectomy remains controversial. Methods: We retrospectively identified 207 patients with in curable gastric cancer who underwent palliative gastrectomy or bypass surgery because of urgent symptoms who were treated from 2002 to 2014. Fifty-nine of these patients who did not receive chemotherapy following surgery were enrolled in the present study. The patients were divided into the palliative gastrectomy group (n = 40) and the bypass surgery group (n = 19). The survival outcomes of the two groups were compared. Independent prognostic factors were identified using multivariate analysis. Results: The rate of patients who underwent gastrectomy was significantly higher among patients whose tumors were located in the upper third (n = 19/20, 95%) than in patients whose tumors were located in the lower or middle third (n = 21/39, 54%, p = 0.001). The median survival time (MST) in the gastrectomy group (145 days) was significantly longer than that in the bypass group (86 days) (p = 0.008). Bypass surgery was identified as an independent prognostic factor in the multivariate analysis (HR = 2.3; 95%CI = 1.3–4.2 p = 0.007). Conclusions: Palliative gastrectomy may improve survival in patients with incurable gastric cancer who show emergent symptoms and who are unfit for chemotherapy.

Original languageEnglish
Pages (from-to)571-579
Number of pages9
JournalWorld Journal of Surgery
Volume43
Issue number2
DOIs
Publication statusPublished - 2019 Feb 15
Externally publishedYes

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Gastrectomy
Stomach Neoplasms
Drug Therapy
Survival
Multivariate Analysis
Neoplasms

ASJC Scopus subject areas

  • Surgery

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Role of Palliative Resection in Patients with Incurable Advanced Gastric Cancer Who are Unfit for Chemotherapy. / Omori, Hayato; Tanizawa, Yutaka; Makuuchi, Rie; Irino, Tomoyuki; Bando, Etsuro; Kawamura, Taiichi; Terashima, Masanori.

In: World Journal of Surgery, Vol. 43, No. 2, 15.02.2019, p. 571-579.

Research output: Contribution to journalArticle

Omori, Hayato ; Tanizawa, Yutaka ; Makuuchi, Rie ; Irino, Tomoyuki ; Bando, Etsuro ; Kawamura, Taiichi ; Terashima, Masanori. / Role of Palliative Resection in Patients with Incurable Advanced Gastric Cancer Who are Unfit for Chemotherapy. In: World Journal of Surgery. 2019 ; Vol. 43, No. 2. pp. 571-579.
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abstract = "Background: The REGATTA trial showed that gastrectomy followed by chemotherapy for advanced gastric cancer with a single non-curable factor did not improve survival outcomes in comparison with chemotherapy alone. Chemotherapy is therefore the mainstay treatment for incurable gastric cancer. However, for patients who are unfit for chemotherapy, the role of palliative gastrectomy remains controversial. Methods: We retrospectively identified 207 patients with in curable gastric cancer who underwent palliative gastrectomy or bypass surgery because of urgent symptoms who were treated from 2002 to 2014. Fifty-nine of these patients who did not receive chemotherapy following surgery were enrolled in the present study. The patients were divided into the palliative gastrectomy group (n = 40) and the bypass surgery group (n = 19). The survival outcomes of the two groups were compared. Independent prognostic factors were identified using multivariate analysis. Results: The rate of patients who underwent gastrectomy was significantly higher among patients whose tumors were located in the upper third (n = 19/20, 95{\%}) than in patients whose tumors were located in the lower or middle third (n = 21/39, 54{\%}, p = 0.001). The median survival time (MST) in the gastrectomy group (145 days) was significantly longer than that in the bypass group (86 days) (p = 0.008). Bypass surgery was identified as an independent prognostic factor in the multivariate analysis (HR = 2.3; 95{\%}CI = 1.3–4.2 p = 0.007). Conclusions: Palliative gastrectomy may improve survival in patients with incurable gastric cancer who show emergent symptoms and who are unfit for chemotherapy.",
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AU - Irino, Tomoyuki

AU - Bando, Etsuro

AU - Kawamura, Taiichi

AU - Terashima, Masanori

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