The Value of Palliative Gastrectomy in Treatment of Patients with Advanced Gastric Cancer

Background & objectives: Gastric cancer accounts for over 10% of cancer-related deaths worldwide and remains the second most frequent cause of cancer death. While surgical resection is considered to be the most suitable treatment for early gastric cancer, it remains debatable for those patients with advanced disease, and adjuvant therapy is still considered the main line of management of these patients. Some studies reported that palliative gastrectomy may be beneficial for survival and improving the quality of life. In spite of that, many studies reported that survival after palliative gastrectomy was associated with significant morbidity and poor quality of life. Our study aims to evaluate the value of palliative gastrectomy with systemic chemotherapy in comparison with systemic chemotherapy alone in management of cases of advanced gastric cancer. Patients and methods: Between June 2013 and March 2017, patients with advanced gastric cancer (T4 N1-3 M0, T1-4 N3 M0, and any T or N with M1) were prospectively included in this study. Enrolled patients were assigned either to have palliative gastrectomy followed by systemic chemotherapy, or to have systemic chemotherapy alone. The patients were followed up regularly after treatment. Postoperative parameters, disease-specific mortality, mean survival & Kaplan-Meier survival analysis were used to assess the outcomes. Results:Twenty-nine patients completed the study. Sixteen patients in the surgery group & 13 in the systemic chemotherapy group were included. Partial gastrectomy was done in 7 cases and total gastrectomy was done in 9 cases. Six patients (37.5%) had postoperative complications & one case (6.3%) of postoperative mortality was recorded. The mean survival of patients of the surgery group was (11.2±1.8 months), which was significantly longer than that of the patients who received systemic chemotherapy alone (7.1±1.3 months). Kaplan-Meier survival analysis showed that the overall survival probability estimate in the surgery group was 32.6% at 1 year and 12.5% at 2 years, compared to 16.1% at 1 year and 0% at 2 years in the chemotherapy group, with difference being statistically significant. Conclusion: Palliative gastrectomy may be done in patients with advanced gastric cancer with acceptable morbidity and mortality rates. It may provide a survival benefit in selected cases of advanced gastric cancer when combined with systemic chemotherapy.