[Palliative surgery in visceral medicine. Exemplified by colorectal and gastric cancer]

Identification of optimal primary tumor resection candidates for metastatic gastric cancer: Nomograms based on propensity score matching

BACKGROUND

This study sought to develop and validate nomograms for screening patients with metastatic gastric cancer (mGC) who are candidates for primary tumor resection (PTR) and evaluating the prognosis of mGC patients after PTR.

METHODS

From 2010 to 2016, we screened mGC patients with complete data from the Surveillance, Epidemiology, and End Results (SEER) database. Depending on whether or not PTR was performed, we categorized patients into surgery and non-surgery groups. A 1:1 propensity score matching (PSM) analysis was used to balance the characteristics of the two groups. The endpoints were overall survival (OS) and cancer-specific survival (CSS). Two predictive nomograms were developed using logistic regression to assess the likelihood of benefit. Two additional prognostic nomograms were developed to assess prognosis in mGC patients after PTR by Cox regression. Finally, nomograms were evaluated using a variety of methodologies.

RESULTS

Our study included 3594 mGC patients who met the criteria. PTR was associated with improved OS and CSS time (median OS time after PSM: 15 vs. 7 months, P < 0.05; median CSS time after PSM: 17 vs. 7 months, P < 0.05). The OS-related predictive nomogram, including age, histologic type, grade, T stage, and chemotherapy, was developed. Moreover, the CSS-related predictive nomogram, including age, histologic type, grade, and chemotherapy, was developed. Sex, histologic type, grade, T stage, N stage, and chemotherapy were found to be correlated with OS. Furthermore, the CSS correlated with histologic type, grade, T stage, N stage, and chemotherapy. Both predictive and prognostic nomograms were found to be valuable and reliable after different types of validation.

CONCLUSION

Predictive nomograms were developed and validated for identifying the optimal PTR mGC candidates. Prognostic nomograms were developed and validated for assessing the prognosis of mGC patients after PTR.

[Palliative surgery of malignant small bowel obstruction after colorectal cancer]

Although invasive surgical procedures in cancer patients can possibly cure malignancy, these strategies are potentially harmful by restricting quality of life and lifetime. Surgical therapies in palliative situations have to be carefully considered and well planned for every individual patient. The case report of the following patient suffering from malignant small bowel obstruction caused by local recurrence of colorectal cancer may make aware of difficulties and doubts in decision-making. After research oft the literature on this topic it is obvious that standards of therapy currently do not exist.