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

ABSTRACT

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.