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BMC Cancer
Published in: BMC Cancer 1/2013

Open Access 01-12-2013 | Research article

Clinical significance of palliative gastrectomy on the survival of patients with incurable advanced gastric cancer: a systematic review and meta-analysis

Authors: Jingxu Sun, Yongxi Song, Zhenning Wang, Xiaowan Chen, Peng Gao, Yingying Xu, Baosen Zhou, Huimian Xu

Published in: BMC Cancer | Issue 1/2013

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Abstract

Background

Palliative gastrectomy for patients with advanced gastric cancer remains controversial. The objective of the present meta-analysis was to analyze survival outcomes and establish a consensus on whether palliative gastrectomy is suitable for patients with incurable advanced gastric cancer and which type of patients should be selected to receive palliative gastrectomy.

Methods

A literature search was conducted in PubMed, EMBASE and the Cochrane Library. The results for overall survival in the meta-analysis are expressed as hazard ratios (HRs) with 95% confidence intervals (CIs).

Results

Of 1647 articles and abstracts reviewed, 14 studies with 3003 patients were eligible for the final analysis. The meta-analysis revealed that palliative gastrectomy is associated with a significantly improvement in overall survival (HR 0.56; 95%CI 0.39–0.80; p < 0.002) compared that of patients treated without palliative gastrectomy. An improvement in survival was also observed in patients with stage M1 gastric cancer who received palliative gastrectomy (HR 0.62; 95%CI 0.49–0.78; p < 0.0001), especially those with peritoneal dissemination (HR = 0.76, 95%CI 0.63–0.92), liver metastasis (HR = 0.41, 95%CI 0.30–0.55), or distant lymph-node metastasis (HR = 0.36, 95%CI 0.23–0.59). Combined hepatic resection may be beneficial for patients who under palliative gastrectomy (HR 0.30; 95%CI 0.15–0.61; p = 0.0008). The overall survival of patients who underwent palliative gastrectomy combined with chemotherapy was significantly improved (HR 0.63; 95%CI 0.47–0.84; p = 0.002).

Conclusions

From the results of the meta-analysis, palliative gastrectomy for patients with incurable advanced gastric cancer may be associated with longer survival, especially for patients with stage M1 gastric cancer. Combined hepatic resection for patients with liver metastasis and chemotherapy may be beneficial factors compared to simple palliative gastrectomy.
Appendix
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Literature
1.
Shibata A, Parsonnet J: Stomach cancer. Cancer Epidemiology and Prevention. Edited by: Schottenfeld D, Fraumeni JF. 2006, New York: Oxford University Press, 707-720. 3CrossRef
2.
Parkin DM, Bray F, Ferlay J, Pisani P: Global cancer statistics, 2002. CA Cancer J Clin. 2005, 55 (2): 74-108. 10.3322/canjclin.55.2.74.CrossRefPubMed
3.
Koizumi W, Narahara H, Hara T, Takagane A, Akiya T, Takagi M, Miyashita K, Nishizaki T, Kobayashi O, Takiyama W, et al: S-1 plus cisplatin versus S-1 alone for first-line treatment of advanced gastric cancer (SPIRITS trial): a phase III trial. Lancet Oncol. 2008, 9 (3): 215-221. 10.1016/S1470-2045(08)70035-4.CrossRefPubMed
4.
Glimelius B, Ekstrom K, Hoffman K, Graf W, Sjoden PO, Haglund U, Svensson C, Enander LK, Linne T, Sellstrom H, et al: Randomized comparison between chemotherapy plus best supportive care with best supportive care in advanced gastric cancer. Ann Oncol. 1997, 8 (2): 163-168. 10.1023/A:1008243606668.CrossRefPubMed
5.
Pyrhonen S, Kuitunen T, Nyandoto P, Kouri M: Randomised comparison of fluorouracil, epidoxorubicin and methotrexate (FEMTX) plus supportive care with supportive care alone in patients with non-resectable gastric cancer. Br J Cancer. 1995, 71 (3): 587-591. 10.1038/bjc.1995.114.CrossRefPubMedPubMedCentral
6.
Kakeji Y, Maehara Y, Tomoda M, Kabashima A, Ohmori M, Oda S, Ohno S, Sugimachi K: Long-term survival of patients with stage IV gastric carcinoma. Cancer. 1998, 82 (12): 2307-2311. 10.1002/(SICI)1097-0142(19980615)82:12<2307::AID-CNCR2>3.0.CO;2-P.CrossRefPubMed
7.
Isobe Y, Nashimoto A, Akazawa K, Oda I, Hayashi K, Miyashiro I, Katai H, Tsujitani S, Kodera Y, Seto Y, et al: Gastric cancer treatment in Japan: 2008 annual report of the JGCA nationwide registry. Gastric Cancer. 2011, 14 (4): 301-316. 10.1007/s10120-011-0085-6.CrossRefPubMedPubMedCentral
8.
Maehara Y, Hasuda S, Koga T, Tokunaga E, Kakeji Y, Sugimachi K: Postoperative outcome and sites of recurrence in patients following curative resection of gastric cancer. Br J Surg. 2000, 87 (3): 353-357. 10.1046/j.1365-2168.2000.01358.x.CrossRefPubMed
9.
Miner TJ, Karpeh MS: Gastrectomy for gastric cancer: defining critical elements of patient selection and outcome assessment. Surg Oncol Clin N Am. 2004, 13 (3): 455-466. 10.1016/j.soc.2004.03.004. viiiCrossRefPubMed
10.
11.
Japanese Gastric Cancer A: Japanese classification of gastric carcinoma - 2nd English edition. Gastric Cancer. 1998, 1 (1): 10-24.CrossRef
12.
Monson JR, Donohue JH, McIlrath DC, Farnell MB, Ilstrup DM: Total gastrectomy for advanced cancer. A worthwhile palliative procedure. Cancer. 1991, 68 (9): 1863-1868. 10.1002/1097-0142(19911101)68:9<1863::AID-CNCR2820680902>3.0.CO;2-1.CrossRefPubMed
13.
Haugstvedt T, Viste A, Eide GE, Soreide O: The survival benefit of resection in patients with advanced stomach cancer: the Norwegian multicenter experience. Norwegian stomach cancer trial. World J Surg. 1989, 13 (5): 617-621. 10.1007/BF01658884. discussion 621–612CrossRefPubMed
14.
Medina-Franco H, Contreras-Saldivar A, Ramos-De La Medina A, Palacios-Sanchez P, Cortes-Gonzalez R, Ugarte JA: Surgery for stage IV gastric cancer. Am J Surg. 2004, 187 (4): 543-546. 10.1016/j.amjsurg.2003.12.045.CrossRefPubMed
15.
Samarasam I, Chandran BS, Sitaram V, Perakath B, Nair A, Mathew G: Palliative gastrectomy in advanced gastric cancer: is it worthwhile?. ANZ J Surg. 2006, 76 (1–2): 60-63.CrossRefPubMed
16.
Hartgrink HH, Putter H, Klein Kranenbarg E, Bonenkamp JJ, van de Velde CJ: Value of palliative resection in gastric cancer. Br J Surg. 2002, 89 (11): 1438-1443. 10.1046/j.1365-2168.2002.02220.x.CrossRefPubMed
17.
Bonenkamp JJ, Sasako M, Hermans J, Van de Velde CJH: Tumor load and surgical palliation in gastric cancer. Hepatogastroenterology. 2001, 48 (41): 1219-1221.PubMed
18.
Maekawa S, Saku M, Maehara Y, Sadanaga N, Ikejiri K, Anai H, Kuwano H, Sugimachi K: Surgical treatment for advanced gastric cancer. Hepatogastroenterology. 1996, 43 (7): 178-186.PubMed
19.
Ouchi K, Sugawara T, Ono H, Fujiya T, Kamiyama Y, Kakugawa Y, Mikuni J, Yamanami H: Therapeutic significance of palliative operations for gastric cancer for survival and quality of life. Eur J Surg Oncol. 1998, 69 (1): 41-44. 10.1002/(SICI)1096-9098(199809)69:1<41::AID-JSO8>3.0.CO;2-K.CrossRef
20.
Miner TJ, Jaques DP, Karpeh MS, Brennan MF: Defining palliative surgery in patients receiving noncurative resections for gastric cancer. J Am Coll Surg. 2004, 198 (6): 1013-1021. 10.1016/j.jamcollsurg.2004.02.007.CrossRefPubMed
21.
Moehler M, Galle PR, Gockel I, Junginger T, Schmidberger H: The multidisciplinary management of gastrointestinal cancer. Multimodal treatment of gastric cancer. Best Pract Res Clin Gastroenterol. 2007, 21 (6): 965-981. 10.1016/j.bpg.2007.10.003.CrossRefPubMed
22.
Sobin L, Gospodarowicz M, Wittekind C: International Union Against Cancer (UICC) TNM classification of malignant tumours[M]. 2010, NewYork: Wiley-Liss, 117-126. 7
23.
Sobin L, Wittekind C: International Union Against Cancer (UICC) TNM classification of malignant tumours [M]. 2002, NewYork: Wiley-Liss, 99-106. 6
24.
Sigurdsson HK, Korner H, Dahl O, Skarstein A, Soreide JA: Palliative surgery for rectal cancer in a national cohort. Colorectal Dis. 2008, 10 (4): 336-343. 10.1111/j.1463-1318.2007.01376.x.CrossRefPubMed
25.
Tierney JF, Stewart LA, Ghersi D, Burdett S, Sydes MR: Practical methods for incorporating summary time-to-event data into meta-analysis. Trials. 2007, 8: 16-10.1186/1745-6215-8-16.CrossRefPubMedPubMedCentral
26.
Kikuchi S, Arai Y, Morise M, Kobayashi N, Tsukamoto H, Shimao H, Sakakibara Y, Hiki Y, Kakita A: Gastric cancer with metastases to the distant peritoneum: a 20-year surgical experience. Hepatogastroenterology. 1998, 45 (22): 1183-1188.PubMed
27.
Saidi RF, ReMine SG, Dudrick PS, Hanna NN: Is there a role for palliative gastrectomy in patients with stage IV gastric cancer?. World J Surg. 2006, 30 (1): 21-27. 10.1007/s00268-005-0129-3.CrossRefPubMed
28.
Nazli O, Yaman I, Tansug T, Isguder AS, Bozdag AD, Bolukbasi H: Palliative surgery for advanced stage (stage IV) gastric adenocarcinoma. Hepatogastroenterology. 2007, 54 (73): 298-303.PubMed
29.
Lin SZ, Tong HF, You T, Yu YJ, Wu WJ, Chen C, Zhang W, Ye B, Li CM, Zhen ZQ, et al: Palliative gastrectomy and chemotherapy for stage IV gastric cancer. J Cancer Res Clin Oncol. 2008, 134 (2): 187-192.CrossRefPubMed
30.
Lupascu C, Andronic D, Ursulescu C, Vasiluta C, Raileanu G, Georgescu S, Niculescu D, Crumpei F, Tarcoveanu E: Palliative gastrectomy in patients with stage IV gastric cancer–our recent experience. Chirurgia (Bucur). 2010, 105 (4): 473-476.
31.
Zhang JZ, Lu HS, Huang CM, Wu XY, Wang C, Guan GX, Zhen JW, Huang HG, Zhang XF: Outcome of palliative total gastrectomy for stage IV proximal gastric cancer. Am J Surg. 2011, 202 (1): 91-96. 10.1016/j.amjsurg.2010.05.014.CrossRefPubMed
32.
Sougioultzis S, Syrios J, Xynos ID, Bovaretos N, Kosmas C, Sarantonis J, Dokou A, Tzivras D, Zografos G, Felekouras E, et al: Palliative gastrectomy and other factors affecting overall survival in stage IV gastric adenocarcinoma patients receiving chemotherapy: a retrospective analysis. Eur J Surg Oncol. 2011, 37 (4): 312-318. 10.1016/j.ejso.2011.01.019.CrossRefPubMed
33.
Kim KH, Lee KW, Baek SK, Chang HJ, Kim YJ, Park DJ, Kim JH, Kim HH, Lee JS: Survival benefit of gastrectomy (plus or minus) metastasectomy in patients with metastatic gastric cancer receiving chemotherapy. Gastric Cancer. 2011, 14 (2): 130-138. 10.1007/s10120-011-0015-7.CrossRefPubMed
34.
Chang YR, Han DS, Kong SH, Lee HJ, Kim SH, Kim WH, Yang HK: The value of palliative gastrectomy in gastric cancer with distant metastasis. Ann Surg Oncol. 2011, 19 (4): 1-9.
35.
Kokkola A, Louhimo J, Puolakkainen P: Does non-curative gastrectomy improve survival in patients with metastatic gastric cancer?. J Surg Oncol. 2012, 106 (2): 193-196. 10.1002/jso.23066.CrossRefPubMed
36.
Chen S, Li YF, Feng XY, Zhou ZW, Yuan XH, Chen YB: Significance of palliative gastrectomy for late-stage gastric cancer patients. J Surg Oncol. 2012, 106 (7): 862-871. 10.1002/jso.23158.CrossRefPubMed
37.
Tokunaga M, Terashima M, Tanizawa Y, Bando E, Kawamura T, Yasui H, Boku N: Survival benefit of palliative gastrectomy in gastric cancer patients with peritoneal metastasis. World J Surg. 2012, 36 (11): 2637-2643. 10.1007/s00268-012-1721-y.CrossRefPubMed
38.
Miki Y, Fujitani K, Hirao M, Kurokawa Y, Mano M, Tsujie M, Miyamoto A, Nakamori S, Tsujinaka T: Significance of surgical treatment of liver metastases from gastric cancer. Anticancer Res. 2012, 32 (2): 665-670.PubMed
39.
Dittmar Y, Rauchfuss F, Goetz M, Jandt K, Scheuerlein H, Heise M, Settmacher U: Non-curative gastric resection for patients with stage 4 gastric cancer–a single center experience and current review of literature. Langenbecks Arch Surg. 2012, 397 (5): 745-753. 10.1007/s00423-012-0902-3.CrossRefPubMed
40.
Wong BC, Lam SK, Wong WM, Chen JS, Zheng TT, Feng RE, Lai KC, Hu WH, Yuen ST, Leung SY, et al: Helicobacter pylori eradication to prevent gastric cancer in a high-risk region of China: a randomized controlled trial. JAMA. 2004, 291 (2): 187-194. 10.1001/jama.291.2.187.CrossRefPubMed
41.
42.
Sarela AI, Yelluri S: Gastric adenocarcinoma with distant metastasis: is gastrectomy necessary?. Arch Surg. 2007, 142 (2): 143-149. 10.1001/archsurg.142.2.143.CrossRefPubMed
43.
Chau I, Norman AR, Cunningham D, Waters JS, Oates J, Ross PJ: Multivariate prognostic factor analysis in locally advanced and metastatic esophago-gastric cancer–pooled analysis from three multicenter, randomized, controlled trials using individual patient data. J Clin Oncol. 2004, 22 (12): 2395-2403. 10.1200/JCO.2004.08.154.CrossRefPubMed
44.
Kim JG, Ryoo BY, Park YH, Kim BS, Kim TY, Im YH, Kang YK: Prognostic factors for survival of patients with advanced gastric cancer treated with cisplatin-based chemotherapy. Cancer Chemother Pharmacol. 2008, 61 (2): 301-307.CrossRefPubMed
45.
Shiraishi N, Sato K, Yasuda K, Inomata M, Kitano S: Multivariate prognostic study on large gastric cancer. J Surg Oncol. 2007, 96 (1): 14-18. 10.1002/jso.20631.CrossRefPubMed
46.
Miyagaki H, Fujitani K, Tsujinaka T, Hirao M, Yasui M, Kashiwazaki M, Ikenaga M, Miyazaki M, Mishima H, Nakamori S: The significance of gastrectomy in advanced gastric cancer patients with non-curative factors. Anticancer Res. 2008, 28 (4C): 2379-2384.PubMed
47.
Mahar AL, Coburn NG, Singh S, Law C, Helyer LK: A systematic review of surgery for non-curative gastric cancer. Gastric Cancer. 2011, 2637: 2643-
48.
Kim DY, Joo JK, Park YK, Ryu SY, Kim YJ, Kim SK, Lee JH: Is palliative resection necessary for gastric carcinoma patients?. Langenbecks Arch Surg. 2008, 393 (1): 31-35.CrossRefPubMed
49.
Li C, Yan M, Chen J, Xiang M, Zhu ZG, Yin HR, Lin YZ: Survival benefit of non-curative gastrectomy for gastric cancer patients with synchronous distant metastasis. J Gastrointest Surg. 2010, 14 (2): 282-288. 10.1007/s11605-009-1095-0.CrossRefPubMed
50.
51.
Stillwell AP, Buettner PG, Ho YH: Meta-analysis of survival of patients with stage IV colorectal cancer managed with surgical resection versus chemotherapy alone. World J Surg. 2010, 34 (4): 797-807. 10.1007/s00268-009-0366-y.CrossRefPubMed
52.
Fujitani K, Yang HK, Kurokawa Y, Parkdo J, Tsujinaka T, Park BJ, Fukuda H, Noh SH, Boku N, Bang YJ, et al: Randomized controlled trial comparing gastrectomy plus chemotherapy with chemotherapy alone in advanced gastric cancer with a single non-curable factor: Japan clinical oncology group study JCOG 0705 and Korea gastric cancer association study KGCA01. Jpn J Clin Oncol. 2008, 38 (7): 504-506. 10.1093/jjco/hyn058.CrossRefPubMed
Metadata
Title
Clinical significance of palliative gastrectomy on the survival of patients with incurable advanced gastric cancer: a systematic review and meta-analysis
Authors
Jingxu Sun
Yongxi Song
Zhenning Wang
Xiaowan Chen
Peng Gao
Yingying Xu
Baosen Zhou
Huimian Xu
Publication date
01-12-2013
Publisher
BioMed Central
Published in
BMC Cancer / Issue 1/2013
Electronic ISSN: 1471-2407
DOI
https://doi.org/10.1186/1471-2407-13-577

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