Clinical outcomes with laparoscopic stage M1, unresected gastric adenocarcinoma

Abstract

Objective: For patients with laparoscopic stage M1 gastric adenocarcinoma, no resection of the primary tumor, and systemic chemotherapy, this study investigated the incidence of subsequent palliative intervention and survival.

Summary background data: Laparoscopy was performed for patients with computed tomography scan stage M0 disease and no significant obstruction or bleeding.

Methods: A prospectively maintained database for 1993 to 2002 was used to identify 165 patients (median age, 63 years) with laparoscopic M1 disease in the peritoneum (P1, adjacent to stomach, 9%; P2, few distant sites, 35%; or P3, disseminated, 30%) or liver (10%) or both (16%). Functional performance status (FPS, Eastern Cooperative Oncology Group) was 0 to 1 (84%) or 2 (16%).

Results: Subsequent intervention was performed on 50% of patients, at median interval of 4 months (range, 1-35 months) after laparoscopy. Intervention was performed on the stomach for obstruction (33%), bleeding (8%), or perforation (1%) or on a distant site for a metastasis-related complication (20%). More than one intervention (maximum, 4) was performed in 21%. Laparotomy was necessary in 12%; the remainder had endoscopic or radiologic procedures or radiation therapy only. There was one intervention-related death. Median survival was 10 months, with 1-year survival of 39%. On multivariate analysis, better FPS (0-1; odds ratio, 4; P=0.001) and limited peritoneal metastasis (P1 or P2; 2; P=0.01) were independently associated with improved survival.

Conclusions: The incidence of subsequent intervention was 50%, but few patients had laparotomy. Intervention-related mortality was minimal. The burden of metastatic disease and functional performance status were important prognostic factors.

FIGURE 1. Percentage distribution of M1 disease at staging laparoscopy: P1, metastasis limited to peritoneum adjacent to the stomach; P2, few metastasis to the distant peritoneum; P3, numerous metastasis to the distant peritoneum; Liver, metastasis limited to the liver; Combined, metastasis to any combination of peritoneum, liver, or nonregional lymph nodes.

FIGURE 2. Incidence of palliative intervention subsequent to laparoscopic detection of M1 gastric adenocarcinoma. Of the 48 patients who had intervention, 12 patients had procedures on both the stomach and on a distant site.

FIGURE 3. Kaplan-Meier survival plot for patients with laparoscopic stage M1 gastric adenocarcinoma (1-year survival, 39%; median survival, 10 months).