J Gastric Cancer.  2013 Dec;13(4):226-231.

Role of Metastasectomy on Overall Survival of Patients with Metastatic Gastric Cancer

• Yang SW
• Kim MG
• Lee JH
• Kwon SJ

Abstract

PURPOSE
The role of metastasectomy has been debatable and unclear in the treatment for patients with metastatic gastric cancer. Therefore, this study was designed to evaluate the role of metastasectomy on the overall survival of these patients.
MATERIALS AND METHODS
In 2,406 patients who underwent gastrectomy for gastric cancer between 1998 and 2010, 188 (7.8%) patients had their first surgery for metastatic gastric cancer. To minimize the bias of systemic chemotherapy, 99 patients who received postoperative chemotherapy (fewer than 2 cycles) were excluded. The primary gastrectomy or metastasectomy had not been enforced in the following cases. Patients with far advanced peritoneal dissemination, multiple liver and lung metastasis (more than 2), and a poor general condition (Eastern Cooperative Oncology Group>2) were excluded. Based on the metastasectomy, the patients were classified into two groups, gastrectomy with metastasectomy and gastrectomy only group.
RESULTS
There was no significant difference between both groups in clinicopathological characteristics except for the mean age (P=0.047). The univariate analysis for overall survival show statistical significances in metastasectomy (P=0.026), distal gastrectomy (P=0.047), and combined resection of another organ (P=0.047) group. With a multivariate analysis, metastasectomy was a significant factor in patient survival after surgery (odds ratio 1.679; P=0.034).
CONCLUSIONS
Based on our results, we assume that a detailed strategy for surgery is needed to improve the overall survival of patients with metastatic gastric cancer. Therefore, we suggest that a metastasectomy can help prolong overall survival in some patients with metastatic gastric cancer.

Keyword

Gastric cancer; Distant metastasis; Metastasectomy; Overall survival

MeSH Terms

Bias (Epidemiology)
Drug Therapy
Gastrectomy
Humans
Liver
Lung
Metastasectomy*
Multivariate Analysis
Neoplasm Metastasis
Stomach Neoplasms*

Figure

• 

  Fig. 1 Survival of patients with metastatic gastric cancer who underwent gastrectomy with and without metastasectomy.

Reference

1. Jemal A, Bray F, Center MM, Ferlay J, Ward E, Forman D. Global cancer statistics. CA Cancer J Clin. 2011; 61:69–90.

2. Yang L, Parkin DM, Ferlay J, Li L, Chen Y. Estimates of cancer incidence in China for 2000 and projections for 2005. Cancer Epidemiol Biomarkers Prev. 2005; 14:243–250.

3. Hartgrink HH, Putter H, Klein Kranenbarg E, Bonenkamp JJ, van de Velde CJ. Dutch Gastric Cancer Group. Value of palliative resection in gastric cancer. Br J Surg. 2002; 89:1438–1443.

4. Swan R, Miner TJ. Current role of surgical therapy in gastric cancer. World J Gastroenterol. 2006; 12:372–379.

5. Maekawa S, Saku M, Maehara Y, Sadanaga N, Ikejiri K, Anai H, et al. Surgical treatment for advanced gastric cancer. Hepatogastroenterology. 1996; 43:178–186.

6. Kikuchi S, Tsukamoto H, Mieno H, Sato K, Kobayashi N, Shimao H, et al. Results of resection of gastric cancer with distant metastases. Hepatogastroenterology. 1998; 45:592–596.

7. Inada T, Ogata Y, Kubota T, Ishihara M, Tomikawa M, Ando J, et al. D2-lymphadenectomy improves the survival of patients with peritoneal cytology-positive gastric cancer. Anticancer Res. 2002; 22:291–294.

8. Medina-Franco H, Contreras-Saldívar A, Ramos-De La Medina A, Palacios-Sanchez P, Cortés-González R, Ugarte JA. Surgery for stage IV gastric cancer. Am J Surg. 2004; 187:543–546.

9. Lin SZ, Tong HF, You T, Yu YJ, Wu WJ, Chen C, et al. Palliative gastrectomy and chemotherapy for stage IV gastric cancer. J Cancer Res Clin Oncol. 2008; 134:187–192.

10. Kobayashi Y, Fukui T, Ito S, Shitara K, Ito S, Hatooka S, et al. Pulmonary metastasectomy for gastric cancer: a 13-year single-institution experience. Surg Today. 2013; 43:1382–1389.

11. Doglietto GB, Pacelli F, Caprino P, Alfieri S, Carriero C, Malerba M, et al. Palliative surgery for far-advanced gastric cancer: a retrospective study on 305 consecutive patients. Am Surg. 1999; 65:352–355.

12. Sarela AI, Yelluri S. Leeds Upper Gastrointestinal Cancer Multidisciplinary Team. Gastric adenocarcinoma with distant metastasis: is gastrectomy necessary? Arch Surg. 2007; 142:143–149.

13. Chow LW, Lim BH, Leung SY, Branicki FJ, Gertsch P. Gastric carcinoma with synchronous liver metastases: palliative gastrectomy or not? Aust N Z J Surg. 1995; 65:719–723.

14. Ouchi K, Sugawara T, Ono H, Fujiya T, Kamiyama Y, Kakugawa Y, et al. Therapeutic significance of palliative operations for gastric cancer for survival and quality of life. J Surg Oncol. 1998; 69:41–44.

15. Kunisaki C, Shimada H, Akiyama H, Nomura M, Matsuda G, Ono H. Survival benefit of palliative gastrectomy in advanced incurable gastric cancer. Anticancer Res. 2003; 23:1853–1858.

16. Ajani JA, Barthel JS, Bekaii-Saab T, Bentrem DJ, D'Amico TA, Das P, et al. NCCN Gastric Cancer Panel. Gastric cancer. J Natl Compr Canc Netw. 2010; 8:378–409.

17. McCarter MD, Fong Y. Role for surgical cytoreduction in multimodality treatments for cancer. Ann Surg Oncol. 2001; 8:38–43.

18. Pollock RE, Roth JA. Cancer-induced immunosuppression: implications for therapy? Semin Surg Oncol. 1989; 5:414–419.

19. Koga S, Kawaguchi H, Kishimoto H, Tanaka K, Miyano Y, Kimura O, et al. Therapeutic significance of noncurative gastrectomy for gastric cancer with liver metastasis. Am J Surg. 1980; 140:356–359.