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. 2022 Jun 17:35:e1648.
doi: 10.1590/0102-672020210002e1648. eCollection 2022.

SURGICAL TREATMENT IN CLINICAL STAGE IV GASTRIC CANCER: A COMPARISON OF DIFFERENT PROCEDURES AND SURVIVAL OUTCOMES

Marcus Fernando Kodama Pertille Ramos  1 , Marina Alessandra Pereira  1 , André Roncon Dias  1 , Tiago Biachi de Castria  1 , Erica Sakamoto  1 , Ulysses Ribeiro-Jr  1 , Bruno Zilberstein  1 , Sérgio Carlos Nahas  1
Affiliations

SURGICAL TREATMENT IN CLINICAL STAGE IV GASTRIC CANCER: A COMPARISON OF DIFFERENT PROCEDURES AND SURVIVAL OUTCOMES

Marcus Fernando Kodama Pertille Ramos et al. Arq Bras Cir Dig. .

Abstract
in English, Portuguese

Aim: Even in clinical stage IV gastric cancer (GC), surgical procedures may be required to palliate symptoms or in an attempt to improve survival. However, the limited survival of these patients raises doubts about who really had benefits from it. This study aimed to analyze the surgical outcomes in stage IV GC treated with surgical procedures without curative intent.

Methods: Retrospective analyses of patients with stage IV GC submitted to surgical procedures including tumor resection, bypass, jejunostomy, and diagnostic laparoscopy were performed. Patients with GC undergoing curative gastrectomy served as the comparison group.

Results: Surgical procedures in clinical stage IV were performed in 363 patients. Compared to curative surgery (680 patients), stage IV patients had a higher rate of comorbidities and ASA III/IV classification. The surgical procedures that were performed included 107 (29.4%) bypass procedures (partitioning/gastrojejunal anastomosis), 85 (23.4%) jejunostomies, 76 (20.9%) resections, and 76 (20.9%) diagnostic laparoscopies. Regarding patients' characteristics, resected patients had more distant metastasis (p=0.011), bypass patients were associated with disease in more than one site (p<0.001), and laparoscopy patients had more peritoneal metastasis (p<0.001). According to the type of surgery, the median overall survival was as follows: resection (13.6 months), bypass (7.8 months), jejunostomy (2.7 months), and diagnostic (7.8 months, p<0.001). On multivariate analysis, low albumin levels, in case of more than one site of disease, jejunostomy, and laparoscopy, were associated with worse survival.

Conclusion: Stage IV resected cases have better survival, while patients submitted to jejunostomy and diagnostic laparoscopy had the worst results. The proper identification of patients who would benefit from surgical resection may improve survival and avoid futile procedures.

Mesmo no câncer gástrico (CG) em estágio clínico IV (ECIV), procedimentos cirúrgicos podem ser necessários para aliviar sintomas ou na tentativa de melhorar a sobrevida. No entanto, a sobrevida limitada desses pacientes levanta dúvidas sobre quem realmente se beneficiaria.

OBJETIVO:: Analisar os resultados cirúrgicos do CG ECIV tratado com procedimentos cirúrgicos sem intenção curativa.

MÉTODOS:: Análise retrospectiva dos pacientes com CG ECIV submetido a procedimentos cirúrgicos, incluindo: ressecção tumoral, bypass, jejunostomia e laparoscopia diagnóstica. Pacientes submetidos à gastrectomia curativa serviram como grupo de comparação.

RESULTADOS:: Os procedimentos cirúrgicos em ECIV foram realizados em 363 pacientes. Comparado à cirurgia curativa (680 pacientes), os pacientes em ECIV apresentaram maior taxa de comorbidades e classificação ASA III/IV. Os procedimentos cirúrgicos realizados foram: 107 (29,4%) bypass (partição/anastomose gastrojejunal), 85 (23,4%) jejunostomias, 76 (20,9%) ressecções e 76 (20,9%) laparoscopias diagnósticas. Em relação às características dos pacientes, os ressecados apresentaram predomínio de metástases distantes (p=0,011); os de bypass associaram-se a doença em mais de um sítio (p<0,001); e os laparoscópicos, metástases peritoneais (p<0,001). A sobrevida global mediana de acordo com o tipo de cirurgia foi: ressecção (13,6 meses), bypass (7,8 meses), jejunostomia (2,7 meses) e diagnóstica (7,8 meses) (p<0,001). Na análise multivariada, níveis baixos de albumina, mais de um sítio de doença, jejunostomia e laparoscopia associaram-se a pior sobrevida.

CONCLUSÃO:: Pacientes em ECIV ressecados apresentam melhor sobrevida, enquanto aqueles submetidos à jejunostomia e laparoscopia diagnóstica tiveram piores resultados. A identificação adequada dos pacientes que se beneficiariam com a ressecção cirúrgica pode melhorar a sobrevida e evitar procedimentos pouco eficazes.

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Conflict of interest statement

Conflict of interest: None

Figures

Figure 1 -
Figure 1 -. Distribution of patients with gastric cancer, according to clinical stage.
Figure 2 -
Figure 2 -. Overall survival of stage IV gastric cancer patients, according to the type of procedure.
See this image and copyright information in PMC

References

    1. Ajani JA, In H, Sano T, et al. American Joint Committee on Cancer (AJCC). Cancer Staging Manual. 8th edition. Stomach. Springer. 2017;17:203 –2 20.
    1. Barchi LC, Ramos MFKP, Dias AR, Forones NM, Carvalho MP, Castro OAP, et al. Brazilian Gastric Cancer Association guidelines (part 2): update on treatment. Arq Bras Cir Dig. 2021;34(1):e1563. doi: 10.1590/0102-672020210001e1563. - DOI - PMC - PubMed
    1. Biondi A, D’Ugo D, Cananzi F, Rausei S, Sicoli F, Santullo F, Laurino A, Ruspi L, Belia F, Quagliuolo V, Persiani R. Prognostic Indicators in Stage IV Surgically Treated Gastric Cancer Patients: A Retrospective Multi-Institutional Study. Dig Surg. 2019;36(4):331–339. doi: 10.1159/000488775. - DOI - PubMed
    1. Bray F, Ferlay J, Soerjomataram I, Siegel RL, Torre LA, Jemal A. Global cancer statistics 2018: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries. CA Cancer J Clin. 2018;68(6):394–424. doi: 10.3322/caac.21492. - DOI - PubMed
    1. Carmona-Bayonas A, Jiménez-Fonseca P, Echavarria I, Sánchez Cánovas M, Aguado G, Gallego J, Custodio A, Hernández R, Viudez A, Cano JM, et al. Surgery for metastases for esophageal-gastric cancer in the real world: Data from the AGAMENON national registry. Eur J Surg Oncol. 2018;44(8):1191–1198. doi: 10.1016/j.ejso.2018.03.019. - DOI - PubMed