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The Value of Palliative Gastrectomy for Gastric Cancer Patients With Intraoperatively Proven Peritoneal Seeding.

Yang K, Liu K, Zhang WH, Lu ZH, Chen XZ, Chen XL, Zhou ZG, Hu JK - Medicine (Baltimore) (2015)

Bottom Line: Clinicopathologic variables and survival were compared.The median survivals among the patients with different classifications of peritoneal metastasis were statistically significant (P = 0.000).Results of subgroup analyses showed that except for P3 patients and patients with multisite distant metastases, overall survival was significantly better in patients with palliative gastrectomy, compared with the nonresection group.

View Article: PubMed Central - PubMed

Affiliation: Department of Gastrointestinal Surgery (KY, KL, W-HZ, Z-HL, X-ZC, X-LC, Z-GZ, J-KH); Laboratory of Gastric cancer, State Key Laboratory of Biotherapy, West China Hospital, Sichuan University, China (KY, KL, W-HZ, Z-HL, X-ZC, X-LC, J-KH).

ABSTRACT
The aim of this study was to evaluate the survival benefit of palliative gastrectomy for gastric cancer patients with peritoneal seeding proven intraoperatively and to identify positive predictive factors for improving survival.The value of palliative resection for gastric cancer patients with peritoneal metastasis is controversial.From 2006 to 2013, 267 gastric cancer patients with intraoperatively identified peritoneal dissemination were retrospectively analyzed. Patients were divided into resection group and nonresection group according to whether a palliative gastrectomy was performed. Clinicopathologic variables and survival were compared. Subgroup analyses stratified by clinicopathologic factors and multivariable analysis for overall survival were also performed.There were 114 patients in the resection group and 153 in nonresection group. The morbidities in the resection and nonresection groups were 14.91% and 5.88%, respectively (P = 0.014). There, however, was no difference in mortality between the 2 groups. The median survival time of patients in the resection group was longer than in nonresection group (14.00 versus 8.57 months, P = 0.000). The median survivals among the patients with different classifications of peritoneal metastasis were statistically significant (P = 0.000). Patients undergoing resection followed by chemotherapy had a significantly longer median survival, compared with that of patients who had chemotherapy alone, those who had resection alone, or those who had not received chemotherapy or resection (P = 0.000). Results of subgroup analyses showed that except for P3 patients and patients with multisite distant metastases, overall survival was significantly better in patients with palliative gastrectomy, compared with the nonresection group. In multivariate analysis, P3 disease (P = 0.000), absence of resection (P = 0.000), and lack of chemotherapy (P = 0.000) were identified as independently associated with poor survival.Palliative gastrectomy might be beneficial to the survival of gastric cancer patients with intraoperatively proven P1/P2 alone, rather than P3. Postoperative palliative chemotherapy could improve survival regardless of operation and should be recommended.

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Overall survival of gastric cancer patients with peritoneal seeding according to treatments received (P = 0.000).
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Figure 6: Overall survival of gastric cancer patients with peritoneal seeding according to treatments received (P = 0.000).

Mentions: The median survivals were reanalyzed according to the different classification of peritoneal metastasis and received treatments to investigate their influences. Patients with P1 had a median survival of 12.17 (95% CI: 9.92, 14.42) months compared with 13.00 (95% CI: 9.71, 16.29) months for those with P2 and 8.07 (95% CI: 7.23, 8.91) months for those with P3 (P = 0.000) (Figure 5). Patients undergoing resection followed by chemotherapy had a significantly longest median survival of 18.37 (95% CI: 16.61, 20.13) months, compared with 11.77 (95% CI: 10.18, 13.36) months for patients who had chemotherapy in the nonresection group, 8.90 (95% CI: 7.69, 10.11) months for those who had resection alone, and 4.73 (95% CI: 3.39, 6.07) months for those who had not received chemotherapy in the nonresection group (P = 0.000) (Figure 6).


The Value of Palliative Gastrectomy for Gastric Cancer Patients With Intraoperatively Proven Peritoneal Seeding.

Yang K, Liu K, Zhang WH, Lu ZH, Chen XZ, Chen XL, Zhou ZG, Hu JK - Medicine (Baltimore) (2015)

Overall survival of gastric cancer patients with peritoneal seeding according to treatments received (P = 0.000).
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4504616&req=5

Figure 6: Overall survival of gastric cancer patients with peritoneal seeding according to treatments received (P = 0.000).
Mentions: The median survivals were reanalyzed according to the different classification of peritoneal metastasis and received treatments to investigate their influences. Patients with P1 had a median survival of 12.17 (95% CI: 9.92, 14.42) months compared with 13.00 (95% CI: 9.71, 16.29) months for those with P2 and 8.07 (95% CI: 7.23, 8.91) months for those with P3 (P = 0.000) (Figure 5). Patients undergoing resection followed by chemotherapy had a significantly longest median survival of 18.37 (95% CI: 16.61, 20.13) months, compared with 11.77 (95% CI: 10.18, 13.36) months for patients who had chemotherapy in the nonresection group, 8.90 (95% CI: 7.69, 10.11) months for those who had resection alone, and 4.73 (95% CI: 3.39, 6.07) months for those who had not received chemotherapy in the nonresection group (P = 0.000) (Figure 6).

Bottom Line: Clinicopathologic variables and survival were compared.The median survivals among the patients with different classifications of peritoneal metastasis were statistically significant (P = 0.000).Results of subgroup analyses showed that except for P3 patients and patients with multisite distant metastases, overall survival was significantly better in patients with palliative gastrectomy, compared with the nonresection group.

View Article: PubMed Central - PubMed

Affiliation: Department of Gastrointestinal Surgery (KY, KL, W-HZ, Z-HL, X-ZC, X-LC, Z-GZ, J-KH); Laboratory of Gastric cancer, State Key Laboratory of Biotherapy, West China Hospital, Sichuan University, China (KY, KL, W-HZ, Z-HL, X-ZC, X-LC, J-KH).

ABSTRACT
The aim of this study was to evaluate the survival benefit of palliative gastrectomy for gastric cancer patients with peritoneal seeding proven intraoperatively and to identify positive predictive factors for improving survival.The value of palliative resection for gastric cancer patients with peritoneal metastasis is controversial.From 2006 to 2013, 267 gastric cancer patients with intraoperatively identified peritoneal dissemination were retrospectively analyzed. Patients were divided into resection group and nonresection group according to whether a palliative gastrectomy was performed. Clinicopathologic variables and survival were compared. Subgroup analyses stratified by clinicopathologic factors and multivariable analysis for overall survival were also performed.There were 114 patients in the resection group and 153 in nonresection group. The morbidities in the resection and nonresection groups were 14.91% and 5.88%, respectively (P = 0.014). There, however, was no difference in mortality between the 2 groups. The median survival time of patients in the resection group was longer than in nonresection group (14.00 versus 8.57 months, P = 0.000). The median survivals among the patients with different classifications of peritoneal metastasis were statistically significant (P = 0.000). Patients undergoing resection followed by chemotherapy had a significantly longer median survival, compared with that of patients who had chemotherapy alone, those who had resection alone, or those who had not received chemotherapy or resection (P = 0.000). Results of subgroup analyses showed that except for P3 patients and patients with multisite distant metastases, overall survival was significantly better in patients with palliative gastrectomy, compared with the nonresection group. In multivariate analysis, P3 disease (P = 0.000), absence of resection (P = 0.000), and lack of chemotherapy (P = 0.000) were identified as independently associated with poor survival.Palliative gastrectomy might be beneficial to the survival of gastric cancer patients with intraoperatively proven P1/P2 alone, rather than P3. Postoperative palliative chemotherapy could improve survival regardless of operation and should be recommended.

Show MeSH
Related in: MedlinePlus