Prognostic Significance Of Palliative Gastrectomy In Incurable Advanced Gastric Cancer

Objective: The role of palliative gastrectomy for patients with incurable advanced gastric cancer requiring surgical intervention remains controversial.The objective of the present retrospective cohort study and meta-analysis was to analyze whether palliative gastrectomy plus chemotherapy can prolong the survival of patients with incurable advanced gastric cancer requiring surgical intervention.Methods: A total of 153 patients from our institute with a diagnosis of incurable advanced gastric cancer between January 2000 and December 2012 were retrospectively reviewed.All patients developed symptoms that required surgical intervention,such as obstruction,perforation,and bleeding.The patients were divided into palliative gastrectomy plus chemotherapy group(n=104)and non-resection operation plus chemotherapy group(n=49)to analyze the value of palliative gastrectomy and to identify potential prognostic factors.We also conducted a metaanalysis of 10 cohort and randomized controlled trial studies to validate the results.Results: Multivariate analysis confirmed that palliative gastrectomy was an independent prognostic factors favorable for prolonged overall survival in incurable advanced gastric cancer patients requiring surgical intervention(P= 0.029).The patients who underwent palliative gastrectomy plus chemotherapy had significantly longer median survival than those who underwent non-resection operation plus chemotherapy(12 months vs.9 months;P =0.020).The patients in non-resection operation plus chemotherapy group had a significantly shorter overall survival than the D1+ lymphadenectomy group,D2 lymphadenectomy group or distal gastrectomy group(P = 0.021,P = 0.007 and P = 0.006).Subgroup analysis showed that age between 50 and 59,male,the Charlson comorbidity index score of 3,Borrmann III type,Borrmann IV type,and peritoneal metastasis with D2 lymphadenectomy were identified preferable candidates for palliative gastrectomy(P=0.036,P=0.020,P=0.008,P=0.032,P=0.007 and P=0.010,respectively).Multivariate analysis indicated that incurable factors were independent prognostic factors for OS(P=0.046).The metaanalysis shows that gastrectomy plus chemotherapy improved the long-term survival in incurable advanced gastric cancer patients(HR 0.47;95%CI 0.33-0.67;P<0.001).Conclusion: Our study suggests that palliative gastrectomy plus chemotherapy may improve the overall survival compared with non-resection operation plus chemotherapy in incurable advanced gastric cancer patients requiring surgical intervention.