Benefits of Palliative Surgery for Far-Advanced Gastric Cancer.docVIP

Original Article 792 Benefits of Palliative Sur gery for Far-Advanced Gastr ic Cancer Chia-Siu Wang, MD; Tzu-Chieh Chao, MD; Yi-Yin Jan, MD; Long-Bin Jeng, MD; Tsann-Long Hwang, MD; Miin-Fu Chen, MD Background: The optimum strategy for palliative surgery in gastric cancer patients remains undetermined. Methods: In total, 525 patients who had undergone palliative surgery between 1994 and 2000 were evaluated in terms of operative mortality, survival, and pallia- tive effect. Patients were grouped according to the UICCs classification of residual tumors (R) after the operation: microscopic residual tumor (R1) (N= 104) and macroscopic residual tumor (R2) (N=421). Gastric resection was performed in all R1 patients and in 257 of the R2 patients. Non-resec- tion procedures were performed in 164 of the R2 patients, including gastroje- junostomies in 64, gastrostomies in 17, jejunostomies in 60, and laparo- tomies only in 23. The operative mortality did not significantly differ among R1 distal gastrec- tomies (4.5%), R2 distal gastrectomies (3.3%), and R1 total gastrectomies (2.9%) ( p = 0.919). R2 total gastrectomies showed a particularly higher operative mortality (10.9%) than did the other resection procedures. The survival time and palliative duration were significantly longer in patients after palliative resection than after non-resection operations. Postoperative chemotherapy prolonged the survival time of patients after palliative surgery. Results: Conclusion: R1 or R2 distal gastrectomies and R1 total gastrectomies have benefits of survival prolongation and symptomatic palliation. However, the use of a total gastrectomy in R2 patients must be selectively reserved for far- advanced cases, otherwise it should be replaced with less-invasive proce- dures to avoid a high operative mortality rate. Postoperative chemotherapy is useful for prolon