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For distant metastatic (M1) gastric adenocarcinoma, a policy to maximally avoid resection of the primary tumor is safe and efficacious.

Cohort study.

Academic tertiary care center.

Sixty-seven (32%) of 211 consecutive patients with adenocarcinoma of the stomach or gastroesophageal junction had synchronous M1 disease on computed tomography or laparoscopy. Sixty-three patients with M1 disease were treated nonoperatively, and complete data sets were available for 40 men and 15 women (median age, 73 years). Pretreatment functional performance status was good in 67%. The primary tumor was at the gastroesophageal junction in 20% and was poorly differentiated in 60%. The M1 disease involved the peritoneum in 80% or was exclusively nonperitoneal in 20%. Systemic chemotherapy was administered to 67%.

Incidence of subsequent invasive …