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Peri-operative Outcomes and Survival Following Palliative Gastrectomy for Gastric Cancer: a Systematic Review and Meta-analysis.
- Source :
-
Journal of gastrointestinal cancer [J Gastrointest Cancer] 2021 Mar; Vol. 52 (1), pp. 41-56. Date of Electronic Publication: 2020 Sep 22. - Publication Year :
- 2021
-
Abstract
- Background: Many patients with gastric cancer present with late stage disease. Palliative gastrectomy remains a contentious intervention aiming to debulk tumour and prevent or treat complications such as gastric outlet obstruction, perforation and bleeding.<br />Methods: We conducted a systematic review of the literature for all papers describing palliative resections for gastric cancer and reporting peri-operative or survival outcomes. Data from peri-operative and survival outcomes were meta-analysed using random effects modelling. Survival data from patients undergoing palliative resections, non-resective surgery and palliative chemotherapy were also combined. This study was registered with the PROSPERO database (CRD42019159136).<br />Results: One hundred and twenty-eight papers which included 58,675 patients contributed data. At 1 year, there was a significantly improved survival in patients who underwent palliative gastrectomy when compared to non-resectional surgery and no treatment. At 2 years following treatment, palliative gastrectomy was associated with significantly improved survival compared to chemotherapy only; however, there was no significant improvement in survival compared to patients who underwent non-resectional surgery after 1 year. Palliative resections were associated with higher rates of overall complications versus non-resectional surgery (OR 2.14; 95% CI, 1.34, 3.46; p < 0.001). However, palliative resections were associated with similar peri-operative mortality rates to non-resectional surgery.<br />Conclusion: Palliative gastrectomy is associated with a small improvement in survival at 1 year when compared to non-resectional surgery and chemotherapy. However, at 2 and 3 years following treatment, survival benefits are less clear. Any survival benefits come at the expense of increased major and overall complications.
- Subjects :
- Antineoplastic Agents therapeutic use
Chemotherapy, Adjuvant methods
Chemotherapy, Adjuvant statistics & numerical data
Cytoreduction Surgical Procedures methods
Cytoreduction Surgical Procedures statistics & numerical data
Disease-Free Survival
Gastrectomy methods
Gastrectomy statistics & numerical data
Gastric Outlet Obstruction etiology
Gastric Outlet Obstruction surgery
Gastrointestinal Hemorrhage etiology
Gastrointestinal Hemorrhage surgery
Humans
Neoadjuvant Therapy methods
Neoadjuvant Therapy statistics & numerical data
Neoplasm Recurrence, Local prevention & control
Palliative Care statistics & numerical data
Perioperative Period
Postoperative Complications etiology
Quality of Life
Spontaneous Perforation etiology
Spontaneous Perforation surgery
Stomach Neoplasms complications
Stomach Neoplasms mortality
Survival Rate
Cytoreduction Surgical Procedures adverse effects
Gastrectomy adverse effects
Neoplasm Recurrence, Local epidemiology
Palliative Care methods
Postoperative Complications epidemiology
Stomach Neoplasms therapy
Subjects
Details
- Language :
- English
- ISSN :
- 1941-6636
- Volume :
- 52
- Issue :
- 1
- Database :
- MEDLINE
- Journal :
- Journal of gastrointestinal cancer
- Publication Type :
- Academic Journal
- Accession number :
- 32959118
- Full Text :
- https://doi.org/10.1007/s12029-020-00519-4