gms | German Medical Science

Introduction: Gastric cancer is one of the most common malignant diseases worldwide. Although curative therapy is widely standardized its prognosis remains poor. Almost one half of all patients with newly diagnosed gastric cancer can not be considered for curative treatment and thus die from the progression of their disease usually within one year. 50% of these patients develop at least one severe tumor-associated complication during the remaining life time. Non-surgical treatment as endoscopy or radiological intervention frequently are not sufficient, therefore palliative surgery in many case becomes the final option, but as well is associated with poor perioperative outcome.

There is a growing number of studies dedicated to that subject, which have been published during the last 50 years, nevertheless the opinion to the impact of non-curative gastric resection for advanced gastric cancer remains to be controversial.

Our study was aimed to assess the effectiveness of non-curative gastric resection on patient survival and the incidence of severe tumor associated complications. Furthermore we defined factors that could be beneficial to select eligible patients for this surgical treatment.

Material and methods: From 1995 to 2011 we collected data from 1074 patients who were treated surgically for gastric cancer in our hospital. Of these, 420 patients were treated with palliative intention. 73 patients underwent non-curative gastric resection. We analyzed clinical, demographic, tumor-associated and pathohistologic data by uni- and multivariate models. Survival analysis was performed by using the Kaplan-Meier method. For all statistical analysis SPSS version 19.0 was used.

Results: Overall survival of non-curatively resected patients was 15 months, whereas in non-resected and non-surgically treated palliative patients it were 6 and 8 months, respectively (p=0.0001).

The longest survival within the non-curatively resected patient group was 111 months. 12% of these patients survived at least 60 months. The incidence of severe tumor-associated complications in the non-curatively resected group was 12% in comparison to the control group with 63%. Patient age up to 45 years as well as not more than two tumor sites were associated with the best overall survival rates. We did not observe a poorer survival in patients with peritoneal carcinosis in comparison to patients who had different non-curative factors. Paitents who underwent a combination of non-curative resection and palliative chemotherapy survived longer than those patients whose underwent surgery or chemotherapy only.

Conclusion: We believe that non-curative gastric resection plus palliative chemotherapy is more beneficial for overall survival as compared to chemotherapy or surgery only. As far as the disease is limited to the primary tumour plus not more than one further organ ivolvement and the patient is up to 45 years old the highest impact on overall survival can be expected. Furthermore, non-curative gastric resection probably may decrease the incidence of severe tumor-associated complications in the remaining life time. These results should be furtherly studied with a controlled clinical trial in the future.