Gastrectomy in Advanced Gastric Cancer Effectively Palliates Symptoms and May Improve Survival in Select Patients

Amy Collins, Ioannis Hatzaras, Carl Schmidt, Katherine Carruthers, W. Scott Melvin, Peter Muscarella, E. Christopher Ellison, Edward Martin, Mark Bloomston

Research output: Contribution to journalArticle

5 Citations (Scopus)

Abstract

Background: The role of gastrectomy in the face of incurable gastric cancer is evolving. We sought to evaluate our experience with incomplete (i.e., R2) gastrectomy in advanced gastric cancer. Methods: We reviewed 210 locally advanced or metastatic gastric cancers (1992-2008). Patient characteristics and outcomes were compared between three groups: gastrectomy (N = 99), exploration without resection (N = 66), and no surgery (N = 45). Results: Clinicopathologic characteristics were similar between groups. Symptoms successfully resolved after gastrectomy in 48 % with a complication rate of 32 % and mortality of 6 %. Overall median survival for all patients was 6.2 months: 10.0 months after gastrectomy, 4.1 months after exploration without resection, and 5.3 months for no surgery (p < 0.001). Perioperative complications were the only predictor of symptom resolution following resection (OR = 0.175). Resolution of symptoms (p < 0.001, Hazards Ratio (HR) = 0.09) and preoperative nausea/vomiting (p = 0.017, HR = 0.55) improved survival, while linitis plastica (p = 0.035, HR = 4.05) and spindle cell morphology (p = 0.011, HR = 1.98) were predictors of poor survival in patients undergoing resection. Conclusions: Gastrectomy in the setting of advanced gastric cancer may be useful in up to half of patients with an acceptable perioperative mortality rate. Symptom resolution offers a potential survival advantage but is dependent upon a complication-free course, so should only be considered selectively.

Original languageEnglish (US)
Pages (from-to)491-496
Number of pages6
JournalJournal of Gastrointestinal Surgery
Volume18
Issue number3
DOIs
StatePublished - Mar 2014
Externally publishedYes

Fingerprint

Gastrectomy
Stomach Neoplasms
Survival
Linitis Plastica
Mortality
Nausea
Vomiting

Keywords

  • Advanced
  • Metastatic gastric cancer
  • Palliative gastrectomy

ASJC Scopus subject areas

  • Surgery
  • Gastroenterology

Cite this

Gastrectomy in Advanced Gastric Cancer Effectively Palliates Symptoms and May Improve Survival in Select Patients. / Collins, Amy; Hatzaras, Ioannis; Schmidt, Carl; Carruthers, Katherine; Melvin, W. Scott; Muscarella, Peter; Ellison, E. Christopher; Martin, Edward; Bloomston, Mark.

In: Journal of Gastrointestinal Surgery, Vol. 18, No. 3, 03.2014, p. 491-496.

Research output: Contribution to journalArticle

Collins, Amy ; Hatzaras, Ioannis ; Schmidt, Carl ; Carruthers, Katherine ; Melvin, W. Scott ; Muscarella, Peter ; Ellison, E. Christopher ; Martin, Edward ; Bloomston, Mark. / Gastrectomy in Advanced Gastric Cancer Effectively Palliates Symptoms and May Improve Survival in Select Patients. In: Journal of Gastrointestinal Surgery. 2014 ; Vol. 18, No. 3. pp. 491-496.
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