Peri-operative Outcomes and Survival Following Palliative Gastrectomy for Gastric Cancer: a Systematic Review and Meta-analysis

J Gastrointest Cancer. 2021 Mar;52(1):41-56. doi: 10.1007/s12029-020-00519-4. Epub 2020 Sep 22.

Abstract

Background: Many patients with gastric cancer present with late stage disease. Palliative gastrectomy remains a contentious intervention aiming to debulk tumour and prevent or treat complications such as gastric outlet obstruction, perforation and bleeding.

Methods: We conducted a systematic review of the literature for all papers describing palliative resections for gastric cancer and reporting peri-operative or survival outcomes. Data from peri-operative and survival outcomes were meta-analysed using random effects modelling. Survival data from patients undergoing palliative resections, non-resective surgery and palliative chemotherapy were also combined. This study was registered with the PROSPERO database (CRD42019159136).

Results: One hundred and twenty-eight papers which included 58,675 patients contributed data. At 1 year, there was a significantly improved survival in patients who underwent palliative gastrectomy when compared to non-resectional surgery and no treatment. At 2 years following treatment, palliative gastrectomy was associated with significantly improved survival compared to chemotherapy only; however, there was no significant improvement in survival compared to patients who underwent non-resectional surgery after 1 year. Palliative resections were associated with higher rates of overall complications versus non-resectional surgery (OR 2.14; 95% CI, 1.34, 3.46; p < 0.001). However, palliative resections were associated with similar peri-operative mortality rates to non-resectional surgery.

Conclusion: Palliative gastrectomy is associated with a small improvement in survival at 1 year when compared to non-resectional surgery and chemotherapy. However, at 2 and 3 years following treatment, survival benefits are less clear. Any survival benefits come at the expense of increased major and overall complications.

Keywords: Gastrectomy; Stomach neoplasms; Survival.

Publication types

  • Comparative Study
  • Meta-Analysis
  • Systematic Review

MeSH terms

  • 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

Substances

  • Antineoplastic Agents