Peri-operative Outcomes and Survival Following Palliative Gastrectomy for Gastric Cancer: a Systematic Review and Meta-a
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REVIEW ARTICLE
Peri-operative Outcomes and Survival Following Palliative Gastrectomy for Gastric Cancer: a Systematic Review and Meta-analysis Joseph Cowling 1 & Bethany Gorman 1 & Afrah Riaz 1 & James R. Bundred 1,2 & Sivesh K. Kamarajah 1,3 & Richard P. T. Evans 1 & Pritam Singh 4 & Ewen A. Griffiths 1,3 Accepted: 9 September 2020 # The Author(s) 2020
Abstract Background Many patients with gastric cancer present with late stage disease. Palliative gastrectomy remains a contentious intervention aiming to debulk tumour and prevent or treat complications such as gastric outlet obstruction, perforation and bleeding. Methods We conducted a systematic review of the literature for all papers describing palliative resections for gastric cancer and reporting peri-operative or survival outcomes. Data from peri-operative and survival outcomes were meta-analysed using random effects modelling. Survival data from patients undergoing palliative resections, non-resective surgery and palliative chemotherapy were also combined. This study was registered with the PROSPERO database (CRD42019159136). Results One hundred and twenty-eight papers which included 58,675 patients contributed data. At 1 year, there was a significantly improved survival in patients who underwent palliative gastrectomy when compared to non-resectional surgery and no treatment. At 2 years following treatment, palliative gastrectomy was associated with significantly improved survival compared to chemotherapy only; however, there was no significant improvement in survival compared to patients who underwent nonresectional surgery after 1 year. Palliative resections were associated with higher rates of overall complications versus nonresectional surgery (OR 2.14; 95% CI, 1.34, 3.46; p < 0.001). However, palliative resections were associated with similar perioperative mortality rates to non-resectional surgery. Conclusion Palliative gastrectomy is associated with a small improvement in survival at 1 year when compared to non-resectional surgery and chemotherapy. However, at 2 and 3 years following treatment, survival benefits are less clear. Any survival benefits come at the expense of increased major and overall complications. Keywords Stomach neoplasms . Gastrectomy . Survival
Electronic supplementary material The online version of this article (https://doi.org/10.1007/s12029-020-00519-4) contains supplementary material, which is available to authorized users. * Ewen A. Griffiths [email protected] 1
College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK
2
College of Medical and Dental Sciences, University of Leeds, Leeds, UK
3
Department of Upper GI surgery, Queen Elizabeth Hospital Birmingham, University Hospitals Birmingham NHS FT, Mindelsohn Way, Birmingham B15 2TH, UK
4
Nottingham Oesophago-Gastric Unit, City Hospital, Hucknall Rd, Nottingham NG5 1PB, UK
Introduction Primary gastric cancer (GC) is the fifth most common malignancy worldwide and frequently presents at a late and incurable stage [1]. The majority of p
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