The Role of Gastric Resection for Advanced Gastric Cancer with Peritoneal Seeding

PURPOSE: Peritoneal seeding is the most common type of metastasis and recurrence in gastric cancer. Recently, some studies have reported the benefits of a noncurative gastrectomy for greatly advanced gastric cancer; nevertheless, there are many controversies. This study was performed to investigate the survival benefit of a noncurative gastrectomy for patients with greatly advanced gastric cancer with peritoneal seeding. METHODS: We retrospectively analyzed 286 gastric-cancer patients who had received operations and who had been proven to have peritoneal seeding without liver metastasis or other hematogenous distant metastasis between January 1990 and December 1997 at the Department of General Surgery, College of Medicine, University of Ulsan. RESULTS: The distribution of the degree of peritoneal seeding was P1 in 84 cases (29.4%), P2 in 56 cases (19.6%), and P3 in 146 cases (51.0%). The duration of median follow-up was 9 months (range: 0.4-83.9 months). A noncurative gastrectomy was performed in 121 cases (42.3%); out of them, a total gastrectomy was performed in 49 cases (40.5%), a distal gastrectomy in 70 cases (57.9%), and a proximal gastrectomy in 2 cases (1.6%). A noncurative gastrec tomy was done 51 of the P1 cases (60.7%), 23 of the P2 cases (41.1%), and 47 of the P3 cases (32.2%). D2 lymph-node dissection was performed in 168 cases (87.6%). Postoperative complications developed in 5 cases with a noncurative gastrectomy, and there was no operative mortality. The median survival times were 11.3 months in P1 cases, 10.5 months in P2 cases, and 6.6 months in P3 cases. The median survival times of noncurative gastrectomy, bypass, and expoloratory laparotomy cases were 11.5 months, 6.6 months, and 6.3 months, respectively; according to the degree of peritoneal seeding, they were 14.8 months, 7.1 months, and 5.3 months in P1 cases, 15.3 months, 8.2 months, and 12.5 months in P2 cases, and 7.6 months, 6.4 months, and 5.7 months in P3 cases, respectively. The difference in survival time between the resection and the nonresection groups had statistical significance regardless of the degree ofperitoneal seeding (p<0.05). In the multivariate analysis, the degree of peritoneal seeding (RR: 1.33) and gastric resection (RR: 1.52) were proven to be significant prognostic factors. CONCLUSION: A noncurative gastrectomy might lengthen the survival time in advanced gastric-cancer patients with peritoneal seeding.

Effectiveness of Gastric Resection in Stage IV Gastric Cancer with Hepatic Metastasis, Peritoneal Seeding, or Distant Lymph Node Metastasis

BACKGROUND : The prognosis for patienys with stage IV gastric cancer is very poor. However, recently, some studies have reported benefits from a gastric resection for metastatic gastric cancer. This clinical study was performed to evaluate the effectiveness of a noncurative gastrectomy in treating stage IV gastric cancer with hepatic metastasis, peritoneal seeding, or distant lymph-node metastasis. METHODS : A retrospective analysis of 114 gastric cancer patients who had undergone a gastric resection, in spite of distant metastasis, between May 1989 and March 1998 at the Department of Surgery, College of Medicine, University of Ulsan, was performed. RESULTS : The average age was 53 years old, and male-to-female ratio was 73 : 41. A total gastrectomy was performed in 48 cases and a distal gastrectomy in 66 cases. Lymph-node dissection was performed to D0, D1, and D2 in 42, 37, and 35 cases, respectively. Postoperative adjuvant chemotherapy was done, mainly by 5-FU and cisplatin. The complication rate was low. The median follow- up was 19 months. The overall average survival times of all patients was 25 months, and the average survival time of patients with hepatic metastasis, peritoneal seeding, and distant lymph-node metastasis, were 28 months, 21 months, and 34 months, respectively. However, there were no statistically significant differences between these survival times. There were six long-term survivors, more than 3 years. The causes of death, in descending order, were renal failure, intestinal obstruction due to peritoneal seeding, hepatic failure due to hepatic metastasis and pneumonia, and sepsis due to lung metastasis. CONCLUSIONS : An aggressive gastric resection for stage IV gastric cancer with hepatic or distant lymph-node metastasis and peritoneal seeding might be useful to lengthen the survival period. A prospective study is needed, especially one with an exact evaluation and analysis of the quality of life.