Abstract
Purpose: The role of palliative gastric resection is still debatable for patients with gastric cancer having non-curative factors such as hepatic and peritoneal metastasis. A guestionnaire survey has been conducted in the Japan Clinical Oncology Group to find out the current status of the palliative resection and to define what patients are candidates for the randomized controlled trial (RCT) comparing the palliative resection with non-resection.
Methods and Results: We sent a questionnaire to 30 facilities and recovered the filled questionnaire from 18. The results are: (1) Currently, the palliative gastric resection is preferred for patients with H1/2 liver metastasis or with P1/2 peritoneal metastasis in many hospitals. (2) Survival benefit obtained by the palliative resection is expected only in patients with H1 liver metastasis or with P0CY1/P1 peritoneal metastasis in many hospitals. (3) Randomized allocation to either the palliative gastric resection or probe laparotomy during the operation in patients whose metastasis is found intraoperatively is considered to be feasible in about half of the hospitals.
Conclusion: This study shows that the patients with H1 liver metastasis or with P0CY1/P1 peritoneal metastasis are acceptable as candidates for RCT clarifying the significance of the palliative gastric resection. However, RCT may be infeasible in patients with resectable liver or peritoneal metastasis because we may be incapable of obtaining consents from both surgeons and patients. In conclusion, RCT should recruit all the patients with liver or peritoneal metastasis despite of its resectability.
