Palliative Surgical Interventions in Advanced Gastric Cancer

Gastric cancer remains a leading cause of cancer-related mortality globally, often presenting at an advanced stage when curative resection is not feasible. In this context, palliative surgical interventions aim to alleviate symptoms, preserve or restore gastrointestinal function and, in selected cases, prolong survival. Procedures typically include palliative gastrectomy, bypass operations such as gastrojejunostomy, and non-curative resections targeting metastases such as isolated hepatic or peritoneal deposits. The choice of intervention hinges on patient performance status, tumour burden, nutritional state and the presence of complications such as gastric outlet obstruction, bleeding or perforation. A growing body of evidence suggests that palliative resection combined with systemic therapy can improve outcomes in carefully selected patients, albeit at the cost of increased operative morbidity. Multidisciplinary evaluation and individual risk stratification have become central to decision-making, with the aim of balancing symptom control, quality of life and survival benefit. Recent advances in minimally invasive techniques and enhanced recovery protocols have further refined the safety profile of these interventions, enabling their application in a wider range of patients with advanced disease.

Research from Nature Portfolio

A large retrospective analysis of metastatic gastric adenocarcinoma patients demonstrated that a combined approach of gastrectomy and systemic chemotherapy achieved the longest median overall survival compared with chemotherapy alone or surgery alone. The cohort, drawn from a national cancer registry, highlighted that selected patients undergoing resection plus chemotherapy experienced a median survival exceeding one year, compared with seven months for chemotherapy alone and under four months for surgery in isolation. Multivariable analyses identified treatment modality, tumour grade and patient age as independent prognostic factors. This study emphasises the potential survival benefit of integrating palliative resection into multimodal care for metastatic gastric cancer.

Palliative Surgical Interventions in Advanced Gastric Cancer publication trend

The graph below shows the total number of articles in palliative surgical interventions in advanced gastric cancer across all publications each year (not limited to Nature Index journals).

Technical terms

Palliative gastrectomy: Surgical removal of part or all of the stomach in patients with incurable disease, intended to relieve symptoms and potentially extend survival rather than achieve cure.

Gastrojejunostomy: A bypass procedure creating an anastomosis between the stomach and the jejunum to relieve gastric outlet obstruction.

Peritoneal carcinomatosis: Dissemination of tumour deposits across the peritoneal surfaces, often signalling advanced disease and poor prognosis.

Propensity score matching: A statistical technique that reduces selection bias by equating groups based on observed characteristics in observational studies.

References

1. Palliative Gastrectomy Improves the Survival of Patients with Metastatic Early-Onset Gastric Cancer: A Retrospective Cohort Study. Current Oncology (2023).
2. Risk Scoring System to Predict Mortality in Gastric Cancer with Peritoneal Carcinomatosis. Medical Sciences (2024).
3. Peri-operative Outcomes and Survival Following Palliative Gastrectomy for Gastric Cancer: a Systematic Review and Meta-analysis. Journal of Gastrointestinal Cancer (2020).
4. Survival outcomes of management in metastatic gastric adenocarcinoma patients. Scientific Reports (2021).