Is resection indicated in gastric cancer deemed curable preoperatively but found to be advanced intraoperatively?

Purpose: This study was designed to evaluate the value of resection and to analyze clinicopathologic data on gastric cancer patients who were evaluated as curable preoperatively but diagnosed as advanced intraoperatively.

Methods: A retrospective analysis was performed on clinical, surgical, and pathological data of 264 patients who had undergone surgery for gastric cancer between January 2008 and October 2012. The patients who were diagnosed in advanced stages during surgical exploration were accepted into the study group. Patients were categorized into the following two groups: non-resection group (NRG) and resection group (RG). We compared the clinicopathologic features of the two groups and investigated the prognostic factors by performing univariate and multivariate analyses.

Results: A total of 79 patients diagnosed with advanced disease in surgical exploration were evaluated. There were 40 patients (50.6%) in the NRG and 39 patients (49.4%) in the RG. The difference in median overall survival between the NRG and the RG was statistically significant (1.7 vs 5 months; p=0.001). In multivariate analysis, age less than 70 years, gastric resection, adjuvant chemotherapy, and male gender were found to be favorable significant independent prognostic factors for overall survival.

Conclusion: Resection seems to be associated with improved overall survival in patients who were diagnosed as advanced intraoperatively. Therefore, patient and tumor-related factors should be taken into consideration before planning resection. Randomized controlled studies are required.