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Gastroduodenal
PWE-168 Palliative resection for advanced gastric and junctional adenocarcinoma (AGJA): which patients will benefit from surgery?
  1. G Piessen1,
  2. W B Robb1,
  3. M Messager1,
  4. J H Lefevre2,
  5. V Pichot-Delhaye3,
  6. A Souadka4,
  7. C Mariette1
  1. 1Department of Digestive Surgery, Lille University Hospital, Lille, France
  2. 2Department of Digestive Surgery, Sainte Antoine University Hospital, Paris, France
  3. 3Department of Digestive Surgery, Lyon University Hospital, Lyon, France
  4. 4Department of Digestive Surgery, Gustave Roussy Institute, Villejuif, France

Abstract

Introduction Whereas palliative chemotherapy offers median survival of 10 months in AGJA, the survival impact of associated primary tumour resection is controversial. The objective of this study was to identify which patients with AGJA will benefit from palliative resection.

Methods Among 3202 patients with GJA registered in 19 French centres between January 1997 and January 2010 and scheduled for surgery, 677 benefited from palliative tumoural resection. Patients' characteristics were compared between palliative and curative groups. In the palliative group, prognostic factors were identified and the impact of each combination of these factors on survival was studied.

Results Median survival of AGJA patients resected with a palliative intent (n=677) was longer than in non-resected patients (n=532) (12.9 vs 8.5 months, p<0.001). Among resected patients, surgery was defined as palliative due to metastasis (n=150, 5.6%), localised (n=122, 4.6%) or diffuse (n=62, 2.3%) peritoneal carcinomatosis (PC), or incomplete tumoural resection (n=343, 12.8%). Overall median survival was 30.0 months, significantly shorter after palliative than curative resection (11.9 vs 48.2 months, p<0.001). Predictors of postoperative mortality were ASA score III–IV (p<0.001) and palliative resection (p=0.020), justifying palliative resection only in ASA I–II patients. Independent prognostic factors in the palliative group were solid organ metastasis (p=0.009), localised PC (p=0.004), diffuse PC (p=0.046) and signet ring cell histology (SRC) (p=0.020). In ASA I–II patients, patients with diffuse PC, metastasis combined with PC or localised PC of SRC had median survivals from 1.3 to 9.3 months. Patients with incomplete resection without metastasis or PC, organ metastasis without PC, or localised PC without SRC had median survival from 12.0 to 18.3 months.

Conclusion In AGJA, only ASA I–II patients, presenting with limited tumoural extension will benefit from palliative resection in combination with chemotherapy. Other clinical presentations have to be enrolled in exclusive palliative chemotherapy programs.

Clinical trial registration number Clinical Trial.gov identifier NCT01249859.

Competing interests None declared.

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