Abstracts
2002 Digestive Disease Week

# 102464 Abstract ID: 102464 Palliative Gastrectomy Improves Survival in Patients with Stomach Cancer Having Peritoneal Metastases Detected on Staging Laparoscopy - A Prospective Follow-Up Study
Enders K Ng, Simon K Wong, Angus C Chan, Danny W Lee, Sydney Chung, Hong Kong, Hong Kong

Background: Staging laparoscopy is increasingly used as a preoperative investigation for patients with stomach cancer. What should be done when peritoneal metastases are detected remains uncertain. Aims of study: To determine the role of palliative gastrectomy in patients with laparoscopic findings of peritoneal seedlings from advanced stomach cancer. Methods: In a 3-year period between 1995 and 1997, 227 patients with biopsy-proven stomach cancer were examined with laparoscopy. Suspicious peritoneal secondaries identified were sampled for frozen section. If peritoneal metastases were confirmed, the mode of operative treatment was at the discretion of individual surgeon. Peri-operative mortality, complications, overall survival, hospital-free survival, and subsequent major events related to tumor progression were recorded prospectively and compared between patients who had undergone gastrectomy and those without gastric resection. Results: 58 patients (34 male and 24 female) with a median age of 62.5 (30-89) years were found to have peritoneal metastases by laparoscopy. 25 patients underwent gastrectomy (7 total, 18 partial), while the remaining 33 were managed by either bypass operation (n=7) or no operation (n=26). The two groups were comparable in demographics, locations of tumor, histological subtypes and ASA anaesthetic risk. Three patients died in the early postoperative period, 1 in the gastrectomy group because of duodenal stump leak and 2 in the non-operative group due to tumor bleeding and pneumonia. With Kaplan Meier cumulative survival analysis and log-rank test, patients undergoing gastrectomy had significantly longer overall survival (median: 257 days vs 158 days, p=0.018) and hospital-free survival (median: 180 days vs 73 days, p=0.016) as compared to those with conservative treatment only. In addition, the gastrectomy group also had less subsequent tumor-related bleeding or obstructive complications than those without gastric resection. Conclusions: Palliative gastrectomy should be carried out even in the presence of peritoneal seedlings because it provides longer and better quality of survival for the patients.