Palliative resection in noncurative gastric cancer patients

Background Palliative resection for noncurable gastric cancer remains controversial, especially in the elderly. This retrospective study was designed to elucidate the clinicopathological factors and operative outcome in patients undergoing palliative gastric resection. Methods From January 1988 to December 2008, 365 patients received palliative gastrectomy while 151 underwent exploratory laparotomy or gastrojejunostomy for noncurative gastric cancer at the Department of Surgery, Taipei Veterans General Hospital. Among the 365 patients, 182 patients (Group A) were aged 70 or less and 183 patients (Group B) were older than 70 years of age. Clinicopathological characteristics and surgical morbidity and mortality were analyzed. Results The overall survival of patients who underwent resection was 10.2 months and that of patients without resection 4.48 months (p<0.001). Compared to Group B, Group A patients were predominantly female (p<0.001), had more advanced Borrmann-type tumors (p = 0.004), more diffuse type of Lauren classification (p<0.001), and poorer cell differentiation (p<0.001). The median overall survival was 10.5 months in Group A and 9.7 months in Group B (p = 0.854). The surgical morbidity was significant higher if the patients had comorbidity (p = 0.028). Both surgical morbidity (13.8% vs. 26.8%, p = 0.028) and mortality (0.5% vs. 6.0%, p<0.0001) were significantly higher in Group B. Conclusions Gastric cancer is less aggressive in the elderly. Palliative gastrectomy can be performed in both younger and older patients, but younger patients tolerate surgery better. More attention should be paid to the perioperative care of the elderly.