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Invited Critique
February 1, 2007

Gastric Adenocarcinoma With Distant Metastasis—Invited Critique

Arch Surg. 2007;142(2):149. doi:10.1001/archsurg.142.2.149

Dr Sarela and colleagues present a nice, timely study on nonoperative management of M1 gastric cancer. Surgeons are in a unique position to care for such patients and should guide appropriate selection of palliative measures. Increasing survival time is a secondary goal in this group; symptom control usually is the patient's and the family's primary concern. Ideally, palliative therapy should be directed to maximizing the patient's quality of life with minimal morbidity while anticipating brief periods of survival (median survival, 7 months). The paradigm shift for us is that surgery is now not usually needed. Although we were trained to consider gastrectomy to prevent subsequent bleeding and obstruction, advances in noninvasive techniques have made it necessary in very few patients.

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