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Background: With more effective systemic chemotherapy, the role for palliative gastrectomy in patients with Stage IV gastric cancer has been questioned.

Methods: Using the National Cancer Data Base we identified 29,655 patients with Stage IV gastric cancer over a 14 year period (1994-2008). Patient demographics, tumor related features, and treatments were analyzed. Overall survival rates were examined using log-rank test power analysis.

Results: There was a decrease in surgical resection from 31.2% in 2000 to 22% in 2008 (p<0.0001), a decrease in radiation from 20% in 2000 to 18.5% in 2008 (p= 0.0009), and an increase in systemic therapy from 45.5% in 2000 to 55.1% in 2008 (p<0.001). There were no differences in gender, age, or histology, but there was a decreasing trend of Caucasians diagnosed (p<0.0001). Survival rates decreased significantly over time p<0.05 (see table below).

Conclusions: Over the past 14 years there has been an increase in the use of systemic chemotherapy and a reduction in palliative gastrectomy for stage IV gastric cancer. The negative impact on survival suggests that treatment pathways be reevaluated.

Observed Survival for Stage IV Gastric CA over time (1994-1997) vs (1998-2002)

Year of Diagnosis	Total patients	1 year (% survival)	2 year (% survival)	3 year (% survival)	4 year (% survival)	5 year (% survival)	95% Confidence Interval	p-value
(1994-1997)	12,132	23.8	12.1	9.1	7.8	6.0	5.6-6.4	p<0.05
(1998-2002)	17,523	22.6	8.4	5.0	3.6	2.9	2.7-3.2	p<0.05