• Advanced gastric cancers
• Meta-analysis
• Palliative surgery
• Reduction surgery
• Unresectable

• Humans
• Stomach Neoplasms/surgery
• Stomach Neoplasms/mortality
• Stomach Neoplasms/pathology
• Treatment Outcome
• Postoperative Complications/epidemiology
• Gastrectomy/methods
• Asymptomatic Diseases
• Survival Rate
• Randomized Controlled Trials as Topic

• 2022-0405-JCC-0319 The 2022 Natural Science Foundation of Gansu Province
• 21gssya-4 Key project of science and technology innovation platform fund of Gansu Provincial People's Hospital

Gastric transcatheter chemoembolization (GTC) is an interventional minimal invasive method, which has never been mentioned in the previous literature for advanced gastric cancer with obstruction. The purpose of this study was to evaluate its safety and efficacy in treating advanced gastric cancer with obstruction.

Advanced gastric cancer patients with obstruction who underwent GTC were retrospectively analysed from June 2017 to January 2020. Baseline information, peri-intervention data, and post-intervention follow-up information were collected. Clinical data obtained before and after the GTC were compared, and the survival of all patients was analysed.

Forty-Two patients were included in this study. 42 (100%) patients achieved technical success, and 22 (52.4%) achieved clinical success. The median time of the GTC was 83 (30.0–180.0) minutes, and the median time of hospitalization after GTC was 3 (1–6) days. One patient experienced abdominal pain during and after GTC. Twenty (47.6%) of the 42 patients underwent gastrectomy after intervention. The pre-intervention gastric outlet obstruction scoring system (GOOSS) was 1 (0–1) and the post-intervention GOOSS was 2 (0–3) (p = 0.000 < 0.05). The median follow-up time was 9.5 (3–35) months, and the overall survival time was 14 months. In the univariate survival analysis, a significant difference was observed between patients who did or did not undergo radical gastrectomy after GTC (p = 0.014 < 0.05).

GTC is a safe and effective treatment, and furthermore, it could be an alternative method in treating advanced gastric cancer with obstruction.

• gastric cancer
• obstruction
• gastric transcatheter chemoembolization
• outcome
• survival

• Endoscopic Stenting
• Gastric Outlet Obstruction
• Gastrojejunostomy
• Upper Gastrointestinal Surgery

• conversion surgery
• gastric cancer
• hepatectomy
• liver metastasis
• stage iv gastric cancer

• Gastrectomy
• Stomach neoplasms
• Survival

• Antineoplastic Agents/therapeutic use
• Chemotherapy, Adjuvant/methods
• Chemotherapy, Adjuvant/statistics & numerical data
• Cytoreduction Surgical Procedures/adverse effects
• Cytoreduction Surgical Procedures/methods
• Cytoreduction Surgical Procedures/statistics & numerical data
• Disease-Free Survival
• Gastrectomy/adverse effects
• Gastrectomy/methods
• Gastrectomy/statistics & numerical data
• Gastric Outlet Obstruction/etiology
• Gastric Outlet Obstruction/surgery
• Gastrointestinal Hemorrhage/etiology
• Gastrointestinal Hemorrhage/surgery
• Humans
• Neoadjuvant Therapy/methods
• Neoadjuvant Therapy/statistics & numerical data
• Neoplasm Recurrence, Local/epidemiology
• Neoplasm Recurrence, Local/prevention & control
• Palliative Care/methods
• Palliative Care/statistics & numerical data
• Perioperative Period
• Postoperative Complications/epidemiology
• Postoperative Complications/etiology
• Quality of Life
• Spontaneous Perforation/etiology
• Spontaneous Perforation/surgery
• Stomach Neoplasms/complications
• Stomach Neoplasms/mortality
• Stomach Neoplasms/therapy
• Survival Rate

• University of Birmingham

Gastric cancer with liver metastasis is defined as advanced gastric cancer and remains one of the deadliest diseases with poor prognosis. Approximately 4–14% of patients with gastric cancers presented with liver metastases at the initial diagnosis. Owing to its incurability, first-line treatment for gastric cancer with liver metastases is systematic chemotherapy, whereas surgery is usually performed to alleviate severe gastrointestinal symptoms. However, continuously emerging retrospective studies confirmed the role of surgery in gastric cancer with liver metastases and showed significantly improved survival rate in patients assigned to a group of surgery with or without chemotherapy. Therefore, more and more convincing data that resulted from prospective randomized clinical trials is in need to clarify the surgery strategies in patients with gastric cancer with liver metastasis.

• R0 resection
• gastric cancer
• liver metastasis
• strategy
• surgery

• Chemotherapy
• Gastrectomy
• Gastric cancer
• Laparotomy
• Metastases

• Aged
• Antineoplastic Agents/therapeutic use
• Female
• Gastrectomy/adverse effects
• Gastrectomy/methods
• Humans
• Male
• Neoplasm Metastasis
• Palliative Care/methods
• Postoperative Complications/epidemiology
• Stomach Neoplasms/drug therapy
• Stomach Neoplasms/pathology
• Stomach Neoplasms/surgery
• Survival Analysis

• Samyang Biopharmaceuticals Corporation, Korea

• Korean Gastric Cancer Association

The benefits of resection for gastric carcinoma patients with non-curative factors remain controversial. Thus, we evaluated the survival benefits of resection in these gastric carcinoma patients. We reviewed the hospital records of 467 gastric carcinoma patients with non-curative factors who had resection (n=305) and compared their clinicopathological findings with individuals (n=162) who underwent bypass or exploration from 1996 to 2010. The 3-year survival rate of patients who had resection was higher than was that of patients who did not (13.2 vs. 7.2%, respectively p<0.001). Cox's proportional hazard regression analysis revealed that only one factor was an independent, statistically significant prognostic parameter: the presence of peritoneal dissemination (risk ratio, 1.37; 95% confidence interval, 1.04–1.79; p<0.05). The 3-year survival rate of patients with peritoneal dissemination was higher in individuals who underwent resection compared with those who did not (9.5 vs. 4.7%, respectively; p<0.001). The current results highlight the improved survival rates of gastric carcinoma patients with non-curative factors who underwent surgery compared with those who did not. Although resection is not curative in this group of patients, we still recommend performing the procedure.

• Gastrectomy
• Stomach Neoplasms
• Survival rate

• Gastric cancer
• laparoscopic surgery
• lymph node dissection
• practice guidelines
• staging
• surgery
• surgical margins
• surgical volumes

• Gastrectomy
• Gastric cancer
• Lymphadenectomy
• Margins
• Reconstruction

Gastrojejunostomy (GJJ) and endoscopic stenting (ES) are palliative treatments for gastric outlet obstruction (GOO) caused by gastric cancer. We compared the outcomes of GJJ with ES by performing a meta-analysis.

Clinical trials that compared GJJ with ES for the treatment of GOO in gastric cancer were included in the meta-analysis. Procedure time, time to resumption of oral intake, duration of hospital stay, patency duration, and overall survival days were compared using weighted mean differences (WMDs). Technical success, clinical success, procedure-related mortality, complications, the rate of re-obstruction, postoperative chemotherapy, and reintervention were compared using odds ratios (ORs).

Nine studies were included in the analysis. Technical success and clinical success were not significantly different between the ES and GJJ groups. The ES group had a shorter procedure time (WMD = −80.89 min, 95% confidence interval [CI] = −93.99 to −67.78, P < 0.001), faster resumption of oral intake (WMD = −3.45 days, 95% CI = –5.25 to −1.65, P < 0.001), and shorter duration of hospital stay (WMD = −7.67 days, 95% CI = −11.02 to −4.33, P < 0.001). The rate of minor complications was significantly higher in the GJJ group (OR = 0.13, 95% CI = 0.04–0.40, P < 0.001). However, the rates of major complications (OR = 6.91, 95% CI = 3.90–12.25, P < 0.001), re-obstruction (OR= 7.75, 95% CI = 4.06–14.78, P < 0.001), and reintervention (OR= 6.27, 95% CI = 3.36–11.68, P < 0.001) were significantly lower in the GJJ group than that in the ES group. Moreover, GJJ was significantly associated with a longer patency duration (WMD = −167.16 days, 95% CI = −254.01 to −89.31, P < 0.001) and overall survival (WMD = −103.20 days, 95% CI = −161.49 to −44.91, P = 0.001).

Both GJJ and ES are effective procedures for the treatment of GOO caused by gastric cancer. ES is associated with better short-term outcomes. GJJ is preferable to ES in terms of its lower rate of stent-related complications, re-obstruction, and reintervention. GJJ should be considered a treatment option for patients with a long life expectancy and good performance status.

The aim of this study is to investigate whether body mass index (BMI) is a prognostic factor in gastric cancer patients with peritoneal dissemination.

This is a retrospective study consisting of 518 patients with a histological diagnosis of gastric cancer with peritoneal dissemination seen at the Sixth Affiliated Hospital of Sun Yat-Sen University and Sun Yat-sen University Cancer Center between January 2010 and April 2014. Patients were followed until December 2015. Chi-square test and Kaplan-Meier survival analysis were used to compare the clinicopathological variables and prognosis.

Univariate analyses showed that significant prognostic factors included palliative gastrectomy (p < 0.001), tumor size (p < 0.001), tumor location (p = 0.011), peritoneal seeding grade (p < 0.001), ascites (p = 0.001), serum CEA level (p = 0.002), serum CA19-9 level (p = 0.033), palliative chemotherapy (p < 0.001), and BMI group (p < 0.001). For patients with palliative chemotherapy, univariate analysis revealed that palliative gastrectomy (p < 0.001), tumor size (p = 0.002), tumor location (p = 0.024), peritoneal seeding grade (p = 0.008), serum CEA level (p = 0.041), and BMI group (p < 0.001). Multivariate analysis revealed that BMI was an independent prognostic factor in gastric cancer patients with peritoneal dissemination, especially in patients who received palliative chemotherapy.

BMI is a prognostic factor for patients who have gastric cancer with peritoneal dissemination, especially in those who received palliative chemotherapy.

• BMI
• Gastric cancer
• Palliative chemotherapy
• Peritoneal dissemination
• Prognosis

The purpose of this study is to suggest a treatment strategy for stage IV gastric cancer by investigating the behavioral difference between initially and recurrent metastatic disease.

We reviewed the medical records of the patients who underwent chemotherapy alone for metastatic gastric cancer between January 2006 and September 2013. Patients were divided into those who underwent chemotherapy for metastatic disease since initial diagnosis (IM group) and for metastatic recurrence after curative surgery (RM group). Survival and causes of death were compared between the 2 groups, and significant prognostic factors were also investigated.

A total of 170 patients were enrolled in this study. Of these patients, 104 were included in the IM group and 66 in the RM group. Overall survival of the IM group did not differ from that of RM (P = 0.569). In the comparison of the causes of death, the IM group had a greater tendency to die from bleeding (P = 0.054) and pneumonia (P = 0.055). In multivariate analysis, bone metastasis (P < 0.001; HR = 2.847), carcinoma peritonei (P = 0.047; HR = 1.766), and the frequency of chemotherapy (P < 0.001; HR = 0.777) were significantly associated with overall survival of IM group.

Disease-burden mainly contributes to the prognosis of metastatic gastric cancer, although noncurative gastrectomy may be helpful in reducing the mortality of initially metastatic disease. Therefore, disease-burden should be also prioritized in determining the treatment strategies for stage IV gastric cancer.

• Gastrectomy
• Metastasis
• Prognosis
• Stomach neoplasms

Background. Palliative gastrectomy has been suggested to improve survival of patients with metastatic gastric cancer, but limitations in study design and availability of robust prognostic factors have cast doubt on the overall merit of this procedure. Methods. The characteristics and clinical outcomes of 173 patients diagnosed between 2008 and 2012 were analyzed to determine the value of palliative gastrectomy and to identify potential prognostic factors. Results. Median overall patient survival was 6.5 months. To attenuate potential selection bias, patients with adequate performance and survival time of ≥ 2 months since diagnosis were included for risk factor analysis (n = 137). The median overall survival was longer for patients who were younger than 60 years, had better performance status (8.7 versus 6.4 months, P = 0.015), received systemic chemotherapy, or had palliative gastrectomy in univariate analyses. Gastrectomy (P = 0.002) remained statistically significant in multivariate analyses. Subgroup analysis showed that patients aged < 60 years, CEA < 5 ng/mL or CA19-9 < 35 U/mL, obtained a survival advantage from palliative gastrectomy. In fact, palliative gastrectomy doubled overall survival for patients who had normal CEA and/or normal CA19-9. Conclusions. Palliative gastrectomy prolongs the survival of metastatic gastric cancer patients with normal CEA and/or CA19-9 level at the time of diagnosis.

• cost analysis
• cost-effectiveness
• palliative stents
• palliative surgery

The survival benefit of non-curative gastric resection for patients with stage IV gastric cancer is still unclear.

Of the patients who underwent open abdominal surgery that was preoperatively intended to be a radical excision procedure for gastric cancer, 72 were diagnosed with stage IV during the operation. At this institution, non-curative gastric resection is performed whenever possible.

Non-curative gastric resection was performed in 44 of the 72 patients. According to the survival analysis, the median survival times in the gastric resection and no-resection groups were 1.9 and 0.9 years, respectively (log-rank test, p = 0.014). Based on the multivariate analysis, we selected gastric resection (hazard ratio [HR] = 0.309; 95 % confidence interval [CI] = 0.152–0.615) and postoperative chemotherapy (HR = 0.136; 95 % CI = 0.056–0.353) as independent factors associated with overall survival (OS). In the subgroup analyses of OS, the factors that were associated with gastric resection having no survival benefit were the existence of distant lymph node or liver metastasis (p = 0.527) and the lack of postoperative chemotherapy (p = 0.589).

For patients who have distant lymph node or liver metastasis and those who will not undergo postoperative chemotherapy, non-curative gastric resection has no survival benefit.

• Non-curative gastric resection
• Postoperative chemotherapy
• Stage IV gastric cancer

• Advanced gastric cancer
• HIPEC
• Laparoscopic surgery
• Lymphadenectomy
• Robotic surgery

• Chemotherapy, Adjuvant
• Clinical Trials, Phase III as Topic
• Female
• Gastrectomy/methods
• Gastrectomy/mortality
• Humans
• Infusions, Parenteral
• Lymph Node Excision/methods
• Lymph Nodes/pathology
• Lymph Nodes/surgery
• Male
• Neoplasm Invasiveness/pathology
• Neoplasm Staging
• Prognosis
• Randomized Controlled Trials as Topic
• Risk Assessment
• Stomach Neoplasms/drug therapy
• Stomach Neoplasms/mortality
• Stomach Neoplasms/pathology
• Stomach Neoplasms/surgery
• Survival Analysis

Systemic chemotherapy is the key treatment for advanced gastric cancer. The benefit of adjuvant surgery following preoperative chemotherapy in gastric cancer with liver metastasis has not been well established.

Forty-nine gastric cancer patients diagnosed with synchronous liver metastasis initially treated with chemotherapy were categorized into the following two groups: surgery group: 25 patients who underwent gastrectomy and subsequently received postoperative chemotherapy and control group: 24 patients who received chemotherapy alone.

The median overall survival of patients in the surgery group and control group was 20.5 and 9.1 months, respectively, (P = 0.006). The median progression-free survival in the surgery group was 10.9 months, with statistical significance when compared with 5.0 months in the control group (P = 0.001). Multivariate analysis demonstrated that response to chemotherapy was the only independent factor in predicting prognosis. The survival of patients who achieved partial response (PR) was prolonged if they received adjuvant surgery (P = 0.024). No significant difference in the survival of patients underwent combined hepatic resection when compared with patients performed gastrectomy only.

For gastric cancer with synchronous liver metastasis, adjuvant gastrectomy followed by chemotherapy might be beneficial for survival comparing with chemotherapy alone, especially in patients response to initial preoperative chemotherapy.

The online version of this article (doi:10.1186/s12957-015-0627-1) contains supplementary material, which is available to authorized users.

• T4
• esophageal carcinoma
• multimodality treatment
• non-curative surgery
• salvage therapy

Either palliative distal gastrectomy or gastrojejunostomy are the initial treatment options for locally advanced gastric cancer with outlet obstruction when curative-intent resection is not feasible. Since chemotherapy is the mainstay for unresectable gastric cancer, the clinical value of palliative distal gastrectomy is controversial.

We retrospectively reviewed the clinical data of patients with gastric cancer with outlet obstruction treated at our institution between January 2002 and December 2012. We compared the clinical outcomes of palliative distal gastrectomy with those of gastrojejunostomy patients and the factors affecting overall survival were evaluated.

Elective palliative distal gastrectomy and gastrojejunostomy were performed in 18 and 25 patients, respectively. The median overall survival times in the gastrojejunostomy and palliative distal gastrectomy groups were statistically equivalent at 8.8 and 8.3 months, respectively (P = 0.73), despite the more locally advanced tumors in the gastrojejunostomy as compared with the palliative distal gastrectomy group. A multivariate Cox regression analysis showed absence of postoperative chemotherapy and higher postoperative complication grade to be associated with worse clinical outcomes.

Palliative distal gastrectomy offers neither survival nor palliative benefit as compared to gastrojejunostomy. Minimizing the morbidity of intervention for outlet obstruction, followed by chemotherapy, appears to be the optimal initial strategy for incurable gastric cancer with outlet obstruction.

• peritoneal metastasis
• gastrectomy
• staging laparoscopy

• Adenocarcinoma/secondary
• Adenocarcinoma/surgery
• Follow-Up Studies
• Gastrectomy
• Humans
• Laparoscopy/statistics & numerical data
• Lymph Node Excision
• Neoplasm Recurrence, Local/diagnosis
• Neoplasm Staging
• Peritoneal Neoplasms/secondary
• Peritoneal Neoplasms/surgery
• Peritoneum/pathology
• Peritoneum/surgery
• Prognosis
• Retrospective Studies
• Stomach Neoplasms/pathology
• Stomach Neoplasms/surgery

• Adjuvant chemotherapy
• Chemoradiation
• Gastric cancer
• Palliative chemotherapy
• Radiotherapy
• Surgery

• Antibodies, Monoclonal, Humanized/administration & dosage
• Antineoplastic Combined Chemotherapy Protocols/therapeutic use
• Chemoradiotherapy/methods
• Chemotherapy, Adjuvant/methods
• Cisplatin/administration & dosage
• Clinical Trials as Topic
• Fluorouracil/administration & dosage
• Humans
• Neoplasm Metastasis
• Palliative Care/methods
• Radiotherapy/methods
• Receptor, ErbB-2/metabolism
• Stomach Neoplasms/drug therapy
• Stomach Neoplasms/radiotherapy
• Stomach Neoplasms/surgery
• Trastuzumab

Palliative gastrectomy for patients with advanced gastric cancer remains controversial. The objective of the present meta-analysis was to analyze survival outcomes and establish a consensus on whether palliative gastrectomy is suitable for patients with incurable advanced gastric cancer and which type of patients should be selected to receive palliative gastrectomy.

A literature search was conducted in PubMed, EMBASE and the Cochrane Library. The results for overall survival in the meta-analysis are expressed as hazard ratios (HRs) with 95% confidence intervals (CIs).

Of 1647 articles and abstracts reviewed, 14 studies with 3003 patients were eligible for the final analysis. The meta-analysis revealed that palliative gastrectomy is associated with a significantly improvement in overall survival (HR 0.56; 95%CI 0.39–0.80; p < 0.002) compared that of patients treated without palliative gastrectomy. An improvement in survival was also observed in patients with stage M1 gastric cancer who received palliative gastrectomy (HR 0.62; 95%CI 0.49–0.78; p < 0.0001), especially those with peritoneal dissemination (HR = 0.76, 95%CI 0.63–0.92), liver metastasis (HR = 0.41, 95%CI 0.30–0.55), or distant lymph-node metastasis (HR = 0.36, 95%CI 0.23–0.59). Combined hepatic resection may be beneficial for patients who under palliative gastrectomy (HR 0.30; 95%CI 0.15–0.61; p = 0.0008). The overall survival of patients who underwent palliative gastrectomy combined with chemotherapy was significantly improved (HR 0.63; 95%CI 0.47–0.84; p = 0.002).

From the results of the meta-analysis, palliative gastrectomy for patients with incurable advanced gastric cancer may be associated with longer survival, especially for patients with stage M1 gastric cancer. Combined hepatic resection for patients with liver metastasis and chemotherapy may be beneficial factors compared to simple palliative gastrectomy.

• gastric carcinoma
• stent
• surgical therapy

• Adult
• Aged
• Female
• Gastric Bypass/adverse effects
• Gastric Outlet Obstruction/etiology
• Gastric Outlet Obstruction/surgery
• Gastroscopy
• Humans
• Kaplan-Meier Estimate
• Length of Stay
• Male
• Middle Aged
• Palliative Care/methods
• Patient Readmission
• Retrospective Studies
• Stents/adverse effects
• Stomach Neoplasms/complications
• Stomach Neoplasms/mortality
• Stomach Neoplasms/surgery
• Treatment Outcome