Tumor load and surgical palliation in gastric cancer

Background/Aims: Most patients with gastric cancer will have resection, eve n if their disease stage is beyond curability. Proper criteria to assess tu mor load in patients deemed noncurative are lacking, and therefore, it is n ot clear which of these patients will benefit from resection. Methodology: Of 996 gastric cancer patients who had laparotomy in a nationa l randomized trial of lymphadenectomy for gastric cancer, 285 (29%) were fo und to be noncurable because of remnant tumor, peritoneal metastases, dista nt lymph node metastases or liver metastases. They underwent a palliative p rocedure considered appropriate by the surgeon. Tumor load in this group wa s analyzed retrospectively by calculating the number of noncurability signs . Results: The number of signs of noncurability was related to the type of su rgical palliation chosen by the surgeon: of those patients with only one si gn of noncurability, 68% had a palliative stomach resection but, of patient s with two or more positive signs of noncurability only 36% had a stomach r esection. Median survival after palliative resection was 253 days compared to 169 days after a nonresective procedure (P = 0.002). This survival advan tage for resected patients disappeared when two or more signs of noncurabil ity were found. Conclusions: For patients deemed noncurative, survival depends on tumor loa d. Accurate preoperative assessment of tumor spread may prevent unnecessary high-risk surgical interventions for patients with noncurative gastric can cer.