Non-curative gastrectomy for advanced gastric cancer does not result in additional risk of postoperative morbidity compared to curative gastrectomy

Background: Non-curative gastrectomy (nCG) for gastric cancer can be considered in selected cases to relieve symptoms. The aim of this study was to evaluate postoperative morbidity and mortality in patients who underwent nCG and compare these results with an intended curative gastrectomy (CG). Materials and methods: All patients who underwent both nCG and CG in the Netherlands were included from the Dutch Upper GI Cancer Audit (2011-2016). In this population-based cohort study postoperative morbidity, mortality, readmissions and short-term oncological outcomes were appraised. Propensity score matching (PSM) was applied to create comparable groups of patients who underwent nCG versus CG, using patient and tumor characteristics. Results: Of the 2202 eligible patients, 115 patients underwent nCG and 2087 underwent CG. After PSM, 115 nCGpatients were matched to 227 CG-patients. More conversions from laparoscopic to open surgery occurred during nCG (10.4 versus 2.6%, p = 0.007). Although postoperative mortality was higher after nCG in the original cohort (9.6 versus 4.8%, p = 0.026), after PSM there was no difference between groups (9.6 versus 7.0%, p = 0.415). Postoperative morbidity, re-interventions and readmission rates did not differ significantly between groups. Resection of additional organs (30.4 versus 11.5%, p < 0.001) and R+ resections (65.2 versus 12.3%, p < 0.001) occurred more frequently during nCG. Conclusions: nCG does not lead to additional postoperative risks compared to CG in patients with similar characteristics, and may be considered in fit patients with advanced gastric cancer. However, randomized trials evaluating potential (survival) benefits of nCG should be awaited.