Outcomes after Gastrectomies in Metastatic Gastric Cancer

Aung Myint Oo, MD1, Young Suk Park, MD2, Dong Joon Shin, MD2, Do Hyun Jung, MD2, Sang Yong Son, MD2, Sang Hoon Ahn, MD2, Do Joong Park, MD, PhD2, Hyung Ho Kim, MD, PhD2. 1Department of General Surgery, Tan Tock Seng Hospital, Singapore, 2Department of Surgery, Seoul National University Bundang Hospital, Korea

INTRODUCTION
Stomach cancer is the third leading cause of cancer death worldwide. The five year observed survival rate of metastatic gastric cancer is around 4% . The role of surgery for metastatic gastric cancer is still controversial. Our objective is to investigate the outcomes of the metastatic gastric cancer patients who underwent gastrectomies.

METHODS
A retrospective review of patients who underwent gastrectomies for metastatic stomach cancer in Seoul National University Bundang Hospital, Korea from May 2003 to September 2013 was done using a prospectively collected gastric cancer database and electronic medical records.

RESULTS
Total 4303 patients underwent gastrectomies for gastric cancer during the study period. 153 patients with the newly diagnosed metastatic gastric cancers were included in the study. 80 (52.3% ) had poorly differentiated adenocarcinoma. 29 (19% ) had distant lymph node metastasis only. 143(93.5% ) received systemic chemotherapy and 140(91.5% ) had open gastrectomies. 89 (58.2% ) underwent debulking gastrectomies and 86 (56.2% ) had combined resection of organs. 18(11.8% ) received intra-operative chemotherapy. The mean age of the patients was 57.37 ± 13.61. Mean operative time was 216.09 ± 67.16 mins. Median length of stay was 11 days (Range 5-80). The 30 days post-operative mortality rate was 1.31% (n=2). The median overall survival for all patients was 17.5 months (range 0.8-56.2). The 1 year and 3 year overall survival rates were 64.5% and 26% respectively. The median overall survival between laparoscopic (32,95% CI 5.24-58.77) versus open (17.1, 95% CI 13.76-20.44) (p=0.228) as well as distant lymph node only (18.7, 95% CI 9.4-27.9) versus other metastasis (17.4, 95% CI 12-22.8) (p=0.4) were not statistically significant. Systemic chemotherapy (HR 0.359, p=0.007) and R0 intent of surgery (HR 0.499, p= 0.002) were significantly related to improved overall survival.

CONCLUSIONS
Our study suggests that there is a beneficial role of surgery in some of the metastatic gastric cancer patients. The systemic chemotherapy and R0 intent of surgery can improve overall survival of those patients. Well-designed prospective clinical studies are needed to confirm our observations.

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