Noncurative Resection for Gastric Cancer Patients: Who Could Benefit?: Determining Prognostic Factors for Patient Selection

• Published in: Annals of surgical oncology 2016-04, Vol.23 (4), p.1212-1219
• Main Authors: Coimbra, Felipe J. F., da Costa, Wilson Luiz, Ribeiro, Héber S. C., Diniz, Alessandro L., de Godoy, André Luís, de Farias, Igor Correia, Filho, Antonio Moris Cury, Fanelli, Marcello Ferretti, Begnami, Maria Dirlei F. S., Soares, Fernando Augusto
• Format: Article
• Language: English
• Subjects: Adenocarcinoma - pathology; Adenocarcinoma - surgery; Adult; Aged; Aged, 80 and over; Female; Follow-Up Studies; Gastrectomy - methods; Gastrointestinal Oncology; Humans; Lymph Node Excision - methods; Male; Medicine; Medicine & Public Health; Middle Aged; Morbidity; Neoplasm Staging; Neoplasm, Residual - diagnosis; Oncology; Patient Selection; Prognosis; Retrospective Studies; Stomach Neoplasms - pathology; Stomach Neoplasms - surgery; Surgery; Surgical Oncology; Survival Rate; Time Factors; Young Adult
• ISSN: 1068-9265; 1534-4681
• DOI: 10.1245/s10434-015-4945-x

Background Resections have long been recommended for patients with incurable gastric cancer. However, high morbidity rates and more efficient chemotherapy regimens have demanded more accurate patient selection. The aim of this study was to analyze the results of gastric cancer patients treated with noncurative resection in a single cancer center. Methods Medical charts of patients treated with a noncurative resection between January 1988 and December 2012 were analyzed. Individuals who had M1 disease were included, along with those with no metastasis but who had an R2 resection. Morbidity, mortality, and survival prognostic factors were analyzed. Results In the period, 192 patients were resected, 159 with previously diagnosed metastatic disease and the other 33 having resection with macroscopic residual disease (R2). A distal gastrectomy was performed in 117 patients and a total resection in 75, with a more limited lymph node dissection in 70 % of cases. A multivisceral resection was deemed necessary in 42 individuals (21.9 %). Overall morbidity was 26.6 % and 60-day mortality was 6.8 %. Splenectomy was the only independent prognostic factor for higher morbidity. Median survival was 10 months, and younger age, distal resection, and chemotherapy were independent prognostic factors for survival. A prognostic score obtained from these factors identified a 20-month median survival in patients with these favorable characteristics. Conclusion Noncurative surgery may be considered in selected gastric cancer patients as long as it has low morbidity and allows the realization of chemotherapy.