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Objective: To compare non-curative surgery and non-surgical management for patients with advanced or metastatic gastric adenocarcinoma.
Design: Retrospective review.
Setting: University referral hospital.
Patients: 289 patients who presented with locally advanced or metastatic gastric cancer from 1995-2010.
Main Outcome Measures: Morbidity, mortality and overall survival (OS).
Results: Ten patients (3.5%) required emergent surgery at initial diagnosis and were excluded from further analysis. Patients who underwent non-emergent surgery at initial diagnosis (n=110, 38.1%) received either gastric resection (group A, n=46, 42%) or surgery without resection (group B, n=64, 58%). Group A included distal gastrectomy (n=25, 54%), total gastrectomy (n=17, 37%), or proximal/esophagogastrectomy (n=4, 9%). Group B included laparoscopy (n=17, 27%), open exploration (n=25, 39%), gastrostomy and/or jejunostomy tube (n=12, 19%), or gastrojejunostomy (n=10, 16%). Group A required intensive care or additional invasive procedures significantly more often than group B (15% vs. 2%, p=0.009). Four patients in group A (8.7%) and 3 patients in group B (4.7%) died within 30 days of surgery (p=0.45). There was no significant difference in OS between groups A and B (median 8.6 vs.10.6 months; p=0.28). When the 110 patients who underwent non-emergent surgery (groups A and B) were compared to non-operatively managed patients (group C, n=169, 58%), OS did not significantly differ (median 10.0 vs. 7.7 months; p=0.81). Three patients in group B (4.7%) and 3 in group C (1.8%) ultimately required an emergent procedure for their primary tumor.
Conclusions: Patients with gastric adenocarcinoma who present with advanced or metastatic disease not amenable to curative resection infrequently require emergent surgery. Noncurative resection is associated with significant perioperative morbidity, high perioperative mortality, and poor OS, and should therefore be avoided.