The role of surgical palliation for advanced gastric cancer is limited because patients with metastatic disease have relatively short survival durations. The operative morbidity and mortality rates are also higher for patients who undergo palliative surgery than for those who undergo curative surgery. Surgery is especially difficult in patients with peritoneal carcinomatosis. Thus, gastrectomy should be considered for intractable bleeding or in cases in which the patient has a dramatic systemic response to chemotherapy with residual local tumor. A combination of gastrostomy for drainage and jejunostomy for enteral nutrition can often offer effective palliation for bowel obstruction.
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