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Palliative Surgery / Advanced Gastric Cancer

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What does it mean if my disease is “too advanced” for curative treatment?

When a gastric cancer diagnosis is caught early enough, doctors hope that the cancer cells are mostly found in one location so that they can all be cut out. This is called a curative gastrectomy – the stomach is removed and as long as there are no cancer cells left, the patient will hopefully enter remission.

Unfortunately, this is not always the case. That is, a lot of the time a patient will only find out about their cancer diagnosis when the disease has spread significantly. This could mean it has invaded multiple layers of the stomach (for example, a T3 or T4 tumor) and/or cancerous cells have moved to other areas of the body (M1, meaning metastasis has happened). So, a tumor would be considered advanced if some of its features make it impossible to remove with the intention of curing the disease completely.

What does this mean for my treatment?

Many advanced gastric cancer patients are treated with chemotherapy. However, it can be difficult to know which chemotherapy routine is best for each patient. Chemotherapy can be physically and emotionally difficult for patients, especially if it is not effective.  

Surgery is usually only done in emergency situations or to reduce discomfort in cases of advanced gastric cancer. Some examples of surgical procedures which could be used are a palliative gastrectomy or bypass surgery. Palliative surgical procedures may be used for a few reasons. Firstly, they can cut out part of the cancerous area which is causing patients to feel pain. An example of this would be a partial gastrectomy. Otherwise, surgery might be used to partially redirect the GI tract. An example of this would be a gastric bypass operation. This might be helpful if the patient has a blockage near the stomach which makes it difficult to eat.

These two research articles hoped to learn better ways to treat advanced gastric cancer patients using surgery.

A systematic review of surgery for non-curative gastric cancer (2012)

https://link.springer.com/article/10.1007/s10120-011-0088-3

  • Mahar, Alyson L., et al. “A systematic review of surgery for non-curative gastric cancer.” Gastric Cancer 15.1 (2012): 125-137. Available from: doi: 10.1007/s10120-011-0088-3.
  • What were they trying to learn?
    1. This paper tries to understand the pros and cons of non-curative gastrectomy in advanced gastric cancer.
  • How did they address their research question?
    1. A total of 59 articles from around the world were reviewed.
    2. The study compared the survival of advanced gastric cancer patients who had different surgical procedures. This included a gastrectomy (total or partial), a surgical bypass, or an exploratory laparotomy.
  • What did they find? Why is this important?
    1. They found that gastrectomy seemed to be the most helpful procedure for patients with advanced gastric cancer.
    2. A patient’s ability to carry out daily tasks, and how they feel about coping with their symptoms is measured by their quality of life. Unfortunately, these studies did not look at  patient quality of life after surgery. This makes it hard to compare treatment options. For example, chemotherapy and gastrectomy patients seem to have similar survival times. But, without knowing about their symptoms and quality of life, it is hard to know which approach is actually better for improving patient lives.
    3. So, more research is needed in order to make conclusions.

Effective palliation and quality of life outcomes in studies of surgery for advanced, non-curative gastric cancer: a systematic review (2011)

https://www.ncbi.nlm.nih.gov/pubmed/21727998

  • Mahar, Alyson L., et al. “Effective palliation and quality of life outcomes in studies of surgery for advanced, non-curative gastric cancer: a systematic review.” Gastric Cancer 15.1 (2012): 138-145. Available from: doi: https://doi.org/10.1007/s10120-011-0070-0.
  • What were they trying to learn?
    1. This study looked at how effective palliative surgery is in treating the symptoms of cancer for patients with stage 3 and 4 disease.
  • How did they address their question?
    1. 9 articles from around the world were analyzed in this paper.
  • What did they find? Why is this important?
    1. The review found that there are many palliative surgical options available. The best option is different for each patient.
    2. Some examples of palliative surgeries include:
      1. surgical bypass (partially redirects the GI tract to a shorter path)
      2. gastrojejunostomy (cutting around the first part of the small intestine to directly connect the stomach and the second part of the small intestine called the jejunum)
      3. Gastrectomy (removing the stomach)
      4. Exploratory laparotomy (small camera inserted through a slit in the abdomen)
    3. They also found that the studies did not use a consistent method to measure quality of life, making it very difficult to compare results. Because of this, it is even more difficult to define which palliative care treatment option is best for patients.
    4. So, more research needs to be done to look into patient quality of life before standard palliative surgery can be used in advanced gastric cancer.