A Clinical Analysis of Stage IV Gastric Cancer

Kwon, Oh Joong; Suh, Jun Suk; Chung, Jung Kee; Hong, In Gyu; Kang, Han Sung

Abstract

From 1988 to 1994, 62 of 262 patients admitted to the Boramae City Hospital with gastric cancer were diagnosed as stage IV. Among them, 5 patients were lost during follow-up, so we analyzed 57 patients retrospectively. This study elucidates whether a palliative resection offered any survival advantage compared to non-resectional treatment. Of the 57 patients, 7 (12%) received a non-curative resection, 36 (63%) a bypass procedure, and 14 (25%) an exploratory laparotomy. There were no operative mortalities and morbidity. Univariate survival analysis demonstrated that the median survival and the 1- and the 2-year survival rates were significantly higher in the resected patients. The median survival and the 1- and the 2-year survival rates were 15 months, 71%, and 57% with a non-curative resection, 7.3 months, 25%, and 8% with bypass procedure, and 6.3 months 33%, and 17% with an exploratory laparotomy. To perform the analysis within relatively homogeneous groups, patients with different operations were further stratified into two groups according to the spread of disease: local (T4) and distant (M1) spread. The median survival of the T4 group was 11.4 months whereas that of the M1 group was 6 months. Although there was no statistical significance in this study, it is noteworthy that, compared to a bypass procedure and a exploratory laparotomy, a non-curative resection seems to have a survival benefit in the M1 group (median survival: 528 days vs 131 days and 182 days, p=0.0926). In conclusion, although this study has the limitations of a retrospective study and a univariate analysis performed without consideration of basic patient characteristics (age, weight loss, nutritional status, etc.), palliative resection seems to be justified in patients with stage IV gastric cancer if it is performed with acceptably low mortality and morbidity.