Clinical outcomes with laparoscopic stage M1, unresected gastric adenocarcinoma Journal Article
| Authors: | Sarela, A. I.; Miner, T. J.; Karpeh, M. S.; Coit, D. G.; Jaques, D. P.; Brennan, M. F. |
| Article Title: | Clinical outcomes with laparoscopic stage M1, unresected gastric adenocarcinoma |
| Abstract: | Objective: For patients with laparoscopic stage M1 gastric adenocarcinoma, no resection of the primary tumor, and systemic chemotherapy, this study investigated the incidence of subsequent palliative intervention and survival. Summary Background Data: Laparoscopy was performed for patients with computed tomography scan stage M0 disease and no significant obstruction or bleeding. Methods: A prospectively maintained database for 1993 to 2002 was used to identify 165 patients (median age, 63 years) with laparoscopic M1 disease in the peritoneum (P1, adjacent to stomach, 9%; P2, few distant sites, 35%; or P3, disseminated, 30%) or liver (10%) or both (16%). Functional performance status (FPS, Eastern Cooperative Oncology Group) was 0 to 1 (84%) or 2 (16%). Results: Subsequent intervention was performed on 50% of patients, at median interval of 4 months (range, 1-35 months) after laparoscopy. Intervention was performed on the stomach for obstruction (33%), bleeding (8%), or perforation (1%) or on a distant site for a metastasis-related complication (20%). More than one intervention (maximum, 4) was performed in 21%. Laparotomy was necessary in 12%; the remainder had endoscopic or radiologic procedures or radiation therapy only. There was one intervention-related death. Median survival was 10 months, with 1-year survival of 39%. On multivariate analysis, better FPS (0-1; odds ratio, 4; P = 0.001) and limited peritoneal metastasis (P1 or P2; 2; P = 0.01) were independently associated with improved survival. Conclusions: The incidence of subsequent intervention was 50%, but few patients had laparotomy. Intervention-related mortality was minimal. The burden of metastatic disease and functional performance status were important prognostic factors. Copyright © 2006 by Lippincott Williams & Wilkins. |
| Keywords: | adult; treatment outcome; aged; middle aged; functional assessment; survival rate; major clinical study; cancer localization; cisplatin; doxorubicin; fluorouracil; systemic therapy; paclitaxel; cancer patient; methotrexate; cancer staging; antineoplastic agent; neoplasm staging; laparoscopy; laparoscopic surgery; laparotomy; prospective study; prospective studies; cancer palliative therapy; adenocarcinoma; computer assisted tomography; proportional hazards models; incidence; tomography, x-ray computed; data base; cancer mortality; irinotecan; postoperative complications; death; endoscopic surgery; neoplasm metastasis; mitomycin; stomach adenocarcinoma; peritoneum metastasis; stomach neoplasms; stomach obstruction; stomach perforation; peritoneum; stomach hemorrhage |
| Journal Title: | Annals of Surgery |
| Volume: | 243 |
| Issue: | 2 |
| ISSN: | 0003-4932 |
| Publisher: | Lippincott Williams & Wilkins |
| Date Published: | 2006-02-01 |
| Start Page: | 189 |
| End Page: | 195 |
| Language: | English |
| DOI: | 10.1097/01.sla.0000197382.43208.a5 |
| PUBMED: | 16432351 |
| PROVIDER: | scopus |
| PMCID: | PMC1448917 |
| DOI/URL: | |
| Notes: | --- - "Cited By (since 1996): 30" - "Export Date: 4 June 2012" - "CODEN: ANSUA" - "Source: Scopus" |
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