Effectiveness of Gastric Resection in Stage IV Gastric Cancer with Hepatic Metastasis, Peritoneal Seeding, or Distant Lymph Node Metastasis

Yook, Jeong Hwan; Suh, Byoung Sun; Kim, Hee Cheol; Kim, Wan Soo; Oh, Sung Tae; Kim, Byung Sik; Park, Kun Choon

Abstract

BACKGROUND
: The prognosis for patienys with stage IV gastric cancer is very poor. However, recently, some studies have reported benefits from a gastric resection for metastatic gastric cancer. This clinical study was performed to evaluate the effectiveness of a noncurative gastrectomy in treating stage IV gastric cancer with hepatic metastasis, peritoneal seeding, or distant lymph-node metastasis.
METHODS
: A retrospective analysis of 114 gastric cancer patients who had undergone a gastric resection, in spite of distant metastasis, between May 1989 and March 1998 at the Department of Surgery, College of Medicine, University of Ulsan, was performed.
RESULTS
: The average age was 53 years old, and male-to-female ratio was 73 : 41. A total gastrectomy was performed in 48 cases and a distal gastrectomy in 66 cases. Lymph-node dissection was performed to D0, D1, and D2 in 42, 37, and 35 cases, respectively. Postoperative adjuvant chemotherapy was done, mainly by 5-FU and cisplatin. The complication rate was low. The median follow- up was 19 months. The overall average survival times of all patients was 25 months, and the average survival time of patients with hepatic metastasis, peritoneal seeding, and distant lymph-node metastasis, were 28 months, 21 months, and 34 months, respectively. However, there were no statistically significant differences between these survival times. There were six long-term survivors, more than 3 years. The causes of death, in descending order, were renal failure, intestinal obstruction due to peritoneal seeding, hepatic failure due to hepatic metastasis and pneumonia, and sepsis due to lung metastasis.
CONCLUSIONS
: An aggressive gastric resection for stage IV gastric cancer with hepatic or distant lymph-node metastasis and peritoneal seeding might be useful to lengthen the survival period. A prospective study is needed, especially one with an exact evaluation and analysis of the quality of life.