Ikeguchi Masahide, Kader Abdul, Takaya Seigo, Fukumoto Youji, Osaki Tomohiro, Saito Hiroaki, Tatebe Shigeru, Wakatsuki Toshiro
Department of Surgery, Division of Surgical Oncology, Faculty of Medicine, Tottori University, 36-1 Nishi-cho, Yonago 683-8504, Japan.
J Gastrointest Cancer. 2013 Jun;44(2):199-202. doi: 10.1007/s12029-012-9471-5.
Treatment of patients with stage IV gastric cancer is controversial. This study was retrospectively designed to elucidate the best treatment for these patients.
Between 2003 and 2010, a total of 558 patients with gastric cancer were treated at the Department of Surgery, Tottori University Hospital, 96 (17.2 %) of whom were diagnosed with stage IV. Among 96, 54 underwent palliative gastrectomy while 42 underwent chemotherapy, exploratory laparotomy, or gastrojejunostomy for unresectable cases. Surgical morbidity, mortality, and patient survival were analyzed with respect to several factors.
Among resected cases, high age, R2 operation, and neoadjuvant chemotherapy did not increase the occurrence of postoperative complications. Patient age, R1 operation, and sufficient chemotherapy were indicated as better prognostic factors for resected stage IV gastric cancers. Even after R2 operation, continuous chemotherapy with changing regimens prolonged R2 resected patients' survival to 25 months (mean). In unresectable cases, bypass operation did not affect patients' survival. But, chemotherapy with changing regimens prolonged the survival of unresectable cases.
Adequate management can resolve surgery-related morbidity, and continuous chemotherapy may be one of the most important prognostic factors in stage IV gastric cancer.
