Role of Laparoscopic Surgery in Palliative Gastric Cancer Management.

Cedric Adelsdorfer, MD, Waldemar Adelsdorfer, MD, Elizabeth Pando, MD, Dulce Momblán, MD, Antonio M Lacy, MD PhD. Department of Gastrointestinal Surgery, Institute of Digestive and Metabolic Diseases (ICMDM), Hospital Clínic of Barcelona

 Introduction
There are few reports about the value of surgery in palliative gastric cancer, even less with the laparoscopic approach, which is proving to be superimposable results to open surgery in early cancer.
Objective
Assess the immediate and medium term in the series of patients undergoing laparoscopic surgery with palliative gastric adenocarcinoma in our institution.
Material and methods.
Prospective study of consecutive patients undergoing laparoscopic surgery for palliative adenocarcinoma between January 2005 and October 2010. Demographic variables are analyzed, short-term results and survival.
Results
48 patients were operated. Exploratory laparoscopy was performed only in 25% (12/48), or gastro jejunostomy in 10.4% (5/48), gastro-jejunal anastomosis in 29.2% (14/48) and resective surgery in 35.4% (17/48). The average age was 71 ± 9 (50-88), 34 male predominance (70.8%). TNM stages are: 4.2% (2 / 48) IIB, 10.4% (5 / 48) IIIA, 12.5% (6/48) IIIB, 12.5% (6/48) IIIC and 60.4% (29/48) stage IV. The operating time of the resected patients was 230 ± 67 minutes, significantly higher than in the other interventions (p<0.001). The conversion rate in the resected was 17.6% (3/17), all due to technical difficulties in mobilizing the tumor. The overall postoperative morbidity was 25% (12/48), being higher in the resected group with 40% (p=0.283). 1 patient in the resected group showed no mortality suture failure, requiring reoperation. Postoperative mortality was 6.3% (3/48), 1 in resected group with intra-abdominal complication without proof of leakage, the other two with a medical cause. The average follow-up 11 ± 8 months (1-33). Overall survival at 24 months was 24.3%. The Kaplan-Meier analysis showed a significantly better survival in cases resected and adjuvant therapy (log-rank test, p=0.034), with a median survival of 25 months (95% CI 14-36.8).
Conclusions
Laparoscopic approach for palliative gastric cancer is a feasible, the rate of morbidity and mortality in resected patients was similar to healing. Palliative resection may increase survival in selected patients.

View Poster