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Metastatic gastric cancer (MGC) patients: Can we improve survival by metastasectomy? A systematic review and meta‐analysis
Author(s) -
Gadde Rahul,
Tamariz Leonardo,
Hanna Mena,
Avisar Eli,
Livingstone Alan,
Franceschi Dido,
Yakoub Danny
Publication year - 2015
Publication title -
journal of surgical oncology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.201
H-Index - 111
eISSN - 1096-9098
pISSN - 0022-4790
DOI - 10.1002/jso.23945
Subject(s) - metastasectomy , medicine , meta analysis , randomized controlled trial , confidence interval , medline , overall survival , oncology , cancer , surgery , metastasis , political science , law
Background Prognosis with current management strategies continues to be dismal in metastatic gastric cancer (MGC) patients. We aimed to evaluate the role of metastasectomy in improving survival. Methods A comprehensive search of MEDLINE, EMBASE, SCOPUS, and Cochrane central databases (1965 to present) was performed. All comparative studies measuring survival in MGC patients undergoing metastasectomy versus other therapies were included. Pooled risk ratios with corresponding 95% confidence intervals (CI) were calculated for survival at 1, 3, and 5 years. Results Sixteen studies with 1712 patients (378 patients in metastasectomy, 1334 patients in other therapies) were eligible for the final meta‐analysis. Median age was 63 years. For patients undergoing metastasectomy, a significant survival advantage was observed at 1 year (RR 0.52, CI 0.43–0.62), 3 year (RR 0.75 CI 0.67–0.83), and 5 year (RR 0.82, CI 0.74–0.91); mean increased difference in survival conferred by metastasectomy averaged between 9.3 and 15.7 months; P < 0.001 for all results. Age, ECOG status, and STROBE score did not contribute to differences in survival. Conclusion Metastasectomy is associated with increased survival at 1, 3, and 5 years in MGC patients. Large prospective randomized controlled trials are critically needed to evaluate the role of metastasectomy in MGC. J. Surg. Oncol. 2015 111:38–45 . © 2015 Wiley Periodicals, Inc.