Role of palliative surgery in advanced gastric carcinoma

Abstract

^{In a 3-year period from July 1995 to June 1998, seventy four patients with advanced primary stomach cancer treated surgically in the Department of Surgery, Tribhuvan University Teaching Hospital, Kathmandu. They were reviewed retrospectively in order to clarify the role of palliative surgery. Out of 74 patients, 69 were treated with palliative surgery (93.2%) and were used for analysis in this study. Five cases were excluded because only 'open and close' was done. There were 43 men and 31 women; the male to female ratio was 1.4:1. The mean age at diagnosis was 57�14 yrs (range 29 to 84 yrs). Almost all patients with gastric carcinoma presented with symptoms of not less than 4 months before subjecting to endoscopic diagnosis . The common symptoms at the presentation were pain (75.4%), vomiting (49.3%), bleeding (13%) and dysphagia (10.1%), respectively. The primary sites of gastric tumours were antrum (65%), body (22%) and cardia (13%) of the stomach, respectively. Most of the advanced gastric cancer were in stage IIIB (40.5%), followed by stage IV (33.8%) and IIIA (25.7%). Radical palliative surgery (RPS) included total or subtotal gastrectomy or partial gastrectomy. Conservative palliative surgery (CPS) comprised of mainly gastroenterostomy and feeding jejunostomy. RPS was performed on 40 patients (58%) and rest of the patients were subjected to CPS. Median postoperative hospital stay was 13�7.4 days and 8�3.2 days in RPS and CPS group, respectively. There was 6% perioperative mortality including one patient who died due to advanced gastric cancer perforation. RPS group had significantly better palliation of symptoms when compared with CPS (83% vs 50%) (p= <0.05). Although the follow-up rate is not good, survival and achievement of a good quality of life were higher following radical palliative than conservative palliative surgery. RPS in locally advanced gastric cancer is safe and should always be attempted whenever possible. Postoperative mortality is low and good palliation can be achieved.}