Background: Patients with advanced-stage gastric cancer may benefit from palliative surgery. The objective of this study was to evaluate trends in the outcomes of gastric resection for the treatment of metastatic stomach cancer using a large national database.
Methods: This was a retrospective observational study using all patient records with the diagnosis of stomach cancer from the Surveillance, Epidemiology, and End Results (SEER) Program for the years 1998-2002. Palliative surgery was classified as surgery performed for patients with SEER-defined “distant” stage cancer. The main outcome measure analyzed was one-year survival. Univariate analyses were performed by chi-square. A multivariable logistic regression was performed to determine which variables were independently predictive of survival.
Results: 9,376 patients with stomach cancer were diagnosed with distant stage disease during the time period of this study. Of those, surgery was not recommended for 55.0% of patients, recommended but not performed for 15.2%, and performed for 29.7%. Overall one-year survival of patients with distant stage disease was 15.8%; survival of patients for which surgery was not recommended was 10.0%, of patients for which surgery was recommended but not performed was 11.2%, and of patients who underwent palliative resection was 30.0%. Of the patients undergoing palliative surgery, mean age was 64.5 years, 57.4% were male, and 70.4% were white. Among surgical patients, one-year survival rates were similar across sex and race; however, a difference was noted across ages with patients ≥70 years having a one-year survival of 28.0% compared to patients <50 years (40.7%) and 50-69 years (40.2%) (overall p<0.0001). When adjusted for sex, age, and race, patients undergoing surgery for distant stage cancer were more likely to survive than patients not undergoing surgery (surgery vs. not recommended O.R. 3.5, 95% C.I. 3.1-4.0; surgery vs. recommended not performed O.R. 3.5, 95% C.I. 2.9-4.2).
Conclusions: Patients with distant stage disease undergoing palliative resection for stomach cancer have improved one-year survival compared to patients not undergoing resection. Though selection bias may influence the survival attained by operative intervention, those patients who did not undergo recommended surgery still had worsened survival compared to the operative cohort. These findings suggest that there is a survival benefit to palliative resection. Increased utilization of palliative surgeries may provide not only symptomatic relief but also increased survival for patients with advanced-stage stomach cancer.