Should gastric cancer with peritoneal metastasis be treated surgically?

Background/aims: This study was attempted to elucidate the role of surgery in patients with gastric carcinoma and peritoneal dissemination.

Methodology: A database of 128 patients was retrospectively examined with univariate and multivariate analyses after selecting 4 treatment factors, 7 tumor factors evaluated preoperatively, 2 tumor factors evaluated intraoperatively, and 2 patient factors.

Results: The overall median survival time was 188 days. Median survival time was 259 days for patients who underwent resection, 173 days for those who underwent bypass operation, and 108 days for those who underwent laparotomy alone. Multivariate analysis revealed only four significant factors for prognosis including computed tomography findings of metastases to the lymph nodes of groups 2 and 3, distant metastasis, ascites, and postoperative status of the patients. Among these factors, the patient status was the most important factor for survival. In 70 patients with a preoperative bad status, the clinical factors affecting survival were analyzed by multivariate analysis exclusive of the postoperative patient status; ascites, resection, bypass operation, and postoperative chemotherapy were significant independent factors. There was no significant difference in safety, efficacy, or prognosis, between the procedures of resection and bypass.

Conclusions: Surgical treatment is not recommended for patients with gastric cancer and peritoneal dissemination when their preoperative status is good. Palliative surgery should be selected when their status is bad. The primary tumor should be resected only when the patient has anemia due to bleeding from the primary tumor.