Felipe J F Coimbra1, Wilson Luiz da Costa2, Héber S C Ribeiro3, Alessandro L Diniz4, André Luís de Godoy5, Igor Correia de Farias6, Antonio Moris Cury Filho7, Marcello Ferretti Fanelli8, Maria Dirlei F S Begnami9, Fernando Augusto Soares10. 1. Department of Abdominal Surgery, A. C. Camargo Cancer Center, São Paulo, Brazil. coimbra.felipe@uol.com.br. 2. Department of Abdominal Surgery, A. C. Camargo Cancer Center, São Paulo, Brazil. dr.wilsoncosta@gmail.com. 3. Department of Abdominal Surgery, A. C. Camargo Cancer Center, São Paulo, Brazil. hsalvadorcr@gmail.com. 4. Department of Abdominal Surgery, A. C. Camargo Cancer Center, São Paulo, Brazil. dr.aldiniz@gmail.com. 5. Department of Abdominal Surgery, A. C. Camargo Cancer Center, São Paulo, Brazil. andreluisgodoy@yahoo.com.br. 6. Department of Abdominal Surgery, A. C. Camargo Cancer Center, São Paulo, Brazil. dr.igorfarias@gmail.com. 7. Department of Abdominal Surgery, A. C. Camargo Cancer Center, São Paulo, Brazil. acury@me.com. 8. Department of Clinical Oncology, A. C. Camargo Cancer Center, São Paulo, Brazil. marcello.fanelli@hcancer.org.br. 9. Department of Surgical Pathology, A. C. Camargo Cancer Center, São Paulo, Brazil. mariadirlei@gmail.com. 10. Department of Surgical Pathology, A. C. Camargo Cancer Center, São Paulo, Brazil. fasoares@accamargo.org.br.
Abstract
BACKGROUND: Resections have long been recommended for patients with incurable gastric cancer. However, high morbidity rates and more efficient chemotherapy regimens have demanded more accurate patient selection. The aim of this study was to analyze the results of gastric cancer patients treated with noncurative resection in a single cancer center. METHODS: Medical charts of patients treated with a noncurative resection between January 1988 and December 2012 were analyzed. Individuals who had M1 disease were included, along with those with no metastasis but who had an R2 resection. Morbidity, mortality, and survival prognostic factors were analyzed. RESULTS: In the period, 192 patients were resected, 159 with previously diagnosed metastatic disease and the other 33 having resection with macroscopic residual disease (R2). A distal gastrectomy was performed in 117 patients and a total resection in 75, with a more limited lymph node dissection in 70 % of cases. A multivisceral resection was deemed necessary in 42 individuals (21.9 %). Overall morbidity was 26.6 % and 60-day mortality was 6.8 %. Splenectomy was the only independent prognostic factor for higher morbidity. Median survival was 10 months, and younger age, distal resection, and chemotherapy were independent prognostic factors for survival. A prognostic score obtained from these factors identified a 20-month median survival in patients with these favorable characteristics. CONCLUSION: Noncurative surgery may be considered in selected gastric cancer patients as long as it has low morbidity and allows the realization of chemotherapy.
BACKGROUND: Resections have long been recommended for patients with incurable gastric cancer. However, high morbidity rates and more efficient chemotherapy regimens have demanded more accurate patient selection. The aim of this study was to analyze the results of gastric cancerpatients treated with noncurative resection in a single cancer center. METHODS: Medical charts of patients treated with a noncurative resection between January 1988 and December 2012 were analyzed. Individuals who had M1 disease were included, along with those with no metastasis but who had an R2 resection. Morbidity, mortality, and survival prognostic factors were analyzed. RESULTS: In the period, 192 patients were resected, 159 with previously diagnosed metastatic disease and the other 33 having resection with macroscopic residual disease (R2). A distal gastrectomy was performed in 117 patients and a total resection in 75, with a more limited lymph node dissection in 70 % of cases. A multivisceral resection was deemed necessary in 42 individuals (21.9 %). Overall morbidity was 26.6 % and 60-day mortality was 6.8 %. Splenectomy was the only independent prognostic factor for higher morbidity. Median survival was 10 months, and younger age, distal resection, and chemotherapy were independent prognostic factors for survival. A prognostic score obtained from these factors identified a 20-month median survival in patients with these favorable characteristics. CONCLUSION: Noncurative surgery may be considered in selected gastric cancerpatients as long as it has low morbidity and allows the realization of chemotherapy.
Authors: Joseph Cowling; Bethany Gorman; Afrah Riaz; James R Bundred; Sivesh K Kamarajah; Richard P T Evans; Pritam Singh; Ewen A Griffiths Journal: J Gastrointest Cancer Date: 2020-09-22