Surgical Procedure and Postoperative S-1 Chemotherapy Deliverability in Symptomatic Stage IV Gastric Cancer
- 1Department of Gastroenterological Surgery, Shizuoka General Hospital, Shizuoka, Japan
- 2Department of Gastrointestinal Surgery, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
- 3Research Support Center, Shizuoka General Hospital, Shizuoka, Japan
Abstract
Background/Aim: Symptomatic incurable stage IV gastric cancer (GC) may require palliative surgery for bleeding or obstruction before systemic therapy. We examined whether procedure type-distal gastrectomy (DG), total gastrectomy (TG), or gastrojejunostomy (GJ)–is associated with nutritional/inflammatory changes, S-1 deliverability, and overall survival (OS).
Patients and Methods: We retrospectively studied 49 patients who underwent palliative DG (n=13), TG (n=20), or GJ (n=16) and then received S-1 as first-line postoperative chemotherapy. Body weight, prognostic nutritional index (PNI), and neutrophil-to-lymphocyte ratio (NLR) were assessed preoperatively and before chemotherapy. Deliverability was evaluated by time to S-1 initiation, continuation beyond 3 months, and treatment modification within 3 months. OS was analyzed using Kaplan-Meier and Cox models.
Results: Postoperative complications were more frequent after GJ (p=0.002); time to S-1 initiation was similar among groups (p=0.144). S-1 continuation beyond 3 months was achieved in 29/49 patients (59.2%; DG 76.9%, TG 55.0%, GJ 50.0%; p=0.302). Weight loss was significantly greater after TG than after DG or GJ, and GJ showed a postoperative decline in PNI and a significantly higher pre-chemotherapy NLR than DG and TG (p=0.015 and p=0.036, respectively). Median OS was 474 days (DG: 812, TG: 422, and GJ: 293 days) and was significantly longer after DG than after TG (p=0.042) or GJ (p=0.003). In multivariate Cox analysis, chemotherapy for ≥3 months (HR=0.46, 95% CI=0.22-0.95; p=0.036) and high PNI (HR=0.31, 95% CI=0.13-0.77; p=0.012) were independent prognostic factors.
Conclusion: In symptomatic incurable stage IV GC treated with palliative surgery followed by S-1, procedure type was associated with distinct perioperative profiles and OS. Maintaining chemotherapy and immuno-nutritional status may be clinically relevant in these patients.
Related
- Modified Kraske Procedure for retrorectal tumors: Early postoperative outcomes and surgical site infection rates in a single-center experience.
- Longitudinal Drain-Fluid Proteomics Reveals Procedure-Specific Signatures of Postoperative Leakage after Pancreatic and Colorectal Surgery
- Surgical procedure and efficacy of KangDuo robot-assisted pyeloplasty for horseshoe kidney
- Recurrent postoperative symptomatic epidural hematoma after thoracic decompression surgery: a case report and literature review
- Management of Symptomatic Genu Recurvatum: Biomechanical Rationale, Etiology-Based Treatment Algorithm, and a Surgical Technical Blueprint
BibTeX
@article{higashizono2026surgical,
title = {{Surgical Procedure and Postoperative S-1 Chemotherapy Deliverability in Symptomatic Stage IV Gastric Cancer}},
author = {KAZUYA HIGASHIZONO and MASAYA WATANABE and ERINA NAGAI and YUSUKE TAKI and MASATO NISHIDA and SHINSUKE SATO and EIJI NAKATANI and YOSHIFUMI BABA and HIDEYUKI KANEMOTO},
journal = {In Vivo},
year = {2026},
month = oct,
doi = {10.21873/invivo.14509},
url = {https://doi.org/10.21873/invivo.14509},
note = {CC BY-NC-ND 4.0},
}
RIS
TY - JOUR
TI - Surgical Procedure and Postoperative S-1 Chemotherapy Deliverability in Symptomatic Stage IV Gastric Cancer
AU - KAZUYA HIGASHIZONO
AU - MASAYA WATANABE
AU - ERINA NAGAI
AU - YUSUKE TAKI
AU - MASATO NISHIDA
AU - SHINSUKE SATO
AU - EIJI NAKATANI
AU - YOSHIFUMI BABA
AU - HIDEYUKI KANEMOTO
PY - 2026
DA - 2026/10/29
JO - In Vivo
DO - 10.21873/invivo.14509
UR - https://doi.org/10.21873/invivo.14509
AB - Background/Aim: Symptomatic incurable stage IV gastric cancer (GC) may require palliative surgery for bleeding or obstruction before systemic therapy. We examined whether procedure type-distal gastrectomy (DG), total gastrectomy (TG), or gastrojejunostomy (GJ)–is associated with nutritional/inflammatory changes, S-1 deliverability, and overall survival (OS). Patients and Methods: We retrospectively studied 49 patients who underwent palliative DG (n=13), TG (n=20), or GJ (n=16) and then received S-1 as first-line postoperative chemotherapy. Body weight, prognostic nutritional index (PNI), and neutrophil-to-lymphocyte ratio (NLR) were assessed preoperatively and before chemotherapy. Deliverability was evaluated by time to S-1 initiation, continuation beyond 3 months, and treatment modification within 3 months. OS was analyzed using Kaplan-Meier and Cox models. Results: Postoperative complications were more frequent after GJ (p=0.002); time to S-1 initiation was similar among groups (p=0.144). S-1 continuation beyond 3 months was achieved in 29/49 patients (59.2%; DG 76.9%, TG 55.0%, GJ 50.0%; p=0.302). Weight loss was significantly greater after TG than after DG or GJ, and GJ showed a postoperative decline in PNI and a significantly higher pre-chemotherapy NLR than DG and TG (p=0.015 and p=0.036, respectively). Median OS was 474 days (DG: 812, TG: 422, and GJ: 293 days) and was significantly longer after DG than after TG (p=0.042) or GJ (p=0.003). In multivariate Cox analysis, chemotherapy for ≥3 months (HR=0.46, 95% CI=0.22-0.95; p=0.036) and high PNI (HR=0.31, 95% CI=0.13-0.77; p=0.012) were independent prognostic factors. Conclusion: In symptomatic incurable stage IV GC treated with palliative surgery followed by S-1, procedure type was associated with distinct perioperative profiles and OS. Maintaining chemotherapy and immuno-nutritional status may be clinically relevant in these patients.
SN - 0258-851X
SN - 1791-7549
ER -