Survival Benefit of Non-curative Gastrectomy for Gastric Cancer Patients with Synchronous Distant Metastasis

The prognosis for gastric cancer patients with distant metastasis is very poor. The purpose of this study was to evaluate the survival benefit of non-curative gastrectomy for gastric cancer patients with synchronous distant metastasis. From 1992 to 2002, 253 gastric cancer patients with synchronous distant metastasis underwent surgery at the Department of Surgery, Ruijin Hospital, China. The clinicopathological characteristics and survival were compared between resection and non-resection groups. The 5-year survival rate was 6.5% for patients in resection group and 0% for patients in non-resection group (P < 0.001). Multivariate analysis showed that liver metastasis, peritoneal dissemination, and non-resection were significantly associated with poor prognosis in gastric cancer patients with distant metastasis. The survival difference between resection and non-resection groups was only observed in patients with single peritoneal dissemination (P < 0.001), but were not in patients with single liver metastasis (P = 0.428), distant nodes involvement (P = 0.490) and multiple metastatic sites (P = 0.192), respectively. Our results suggests that there were no survival benefit from non-curative gastrectomy for patients with single liver, distant nodes, or multiple sites metastasis. However, only patients with single peritoneal dissemination had survival benefit from non-curative resection. The value of non-curative resection should be evaluated by well-designed clinical trials.