Evaluation of the role of palliative gastrectomy in management of patients with advanced gastric cancer

Background and objectives
Gastric cancer is responsible for more than 10% of cancer-related deaths worldwide and remains the second most common cause of cancer-related death. Surgical resection is considered the most effective treatment for early gastric cancer, but its value remains debatable for patients with advanced disease. Adjuvant therapy is still considered the main line of management of these patients. Some studies had reported that palliative gastrectomy may have a beneficial effect for survival and quality of life in patients with advanced disease. On the contrary, many studies had reported that 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 the management of cases of advanced gastric cancer.
Patients and methods
Between May 2015 and May 2020, patients with advanced gastric cancer (T4N1-3 M0, T1-4N3M0, 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, and Kaplan–Meier survival analysis were used to assess the outcomes.
Results
A total of 35 patients completed the study, including 20 patients in the surgery group and 15 in the systemic chemotherapy group. Partial gastrectomy was done in nine cases, and total gastrectomy was done in 11 cases. Seven (35%) patients had postoperative complications, and two (10%) cases of postoperative mortality were recorded. The mean survival length of patients of the surgery group was 11.3±1.6 months, which was significantly longer than that of the patients who received systemic chemotherapy alone (7.3±1.1 months). Kaplan–Meier survival analysis showed that the overall survival probability estimate in the surgery group was 32.8% at 1 year and 12.4% at 2 years, compared with 15.9% at 1 year and 0% at 2 years in the chemotherapy group, with difference being statistically significant.
Conclusion
Palliative gastrectomy can be done in patients with advanced gastric cancer with acceptable morbidity and mortality rates. It may provide a survival benefit in select cases of advanced gastric cancer when combined with systemic chemotherapy.