Prognostic Factors Affecting Survival After Multivisceral Resection in Patients with Clinical T4b Gastric Cancer
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The prognosis and survival of patients with advanced gastric cancer is poor. Although completeness of resection (R0) is one of the most important factors affecting survival, multivisceral resection (MVR) for locally advanced (clinical T4b, cT4b) gastric cancer remains controversial. The aim of this study was to evaluate the factors affecting prognosis and survival after MVR in patients with cT4b gastric cancer.
Between 2005 and 2015, we retrospectively reviewed the medical records of 103 patients who underwent MVR for cT4b gastric cancer with suspected direct invasion to adjacent organs. Patient characteristics, related complications, long-term survival, and prognostic factors of cT4b gastric cancer were analyzed.
Postoperative mortality and morbidity rates of patients after MVR were 1.0 and 37.9%, respectively. R0 resection was achieved in 82.5% patients, all of whom had a significantly improved survival rate. Overall survival rates at 1 and 3 years were 78.3 and 47.7% for R0 resection and 46.6 and 14.3% for R1 resection, respectively (R0 vs. R1, P < 0.002). Multivariate analysis revealed that completeness of resection (R0) was an independent prognostic factor associated with longer survival.
In patients with cT4b gastric cancer, gastrectomy with MVR to achieve an R0 resection can be performed with acceptable postoperative morbidity and mortality rates and can have a positive impact on long-term survival.
KeywordsT4 gastric cancer Prognostic factors Multivisceral resection Complete resection
Study design: Kazuhito Mita, Hideki Asakawa, and Hideto Ito. Acquisition of data: Kazuhito Mita, Toshio Katsube, Ayaka Tsuboi, and Nobuyoshi Yamazaki. Analysis and interpretation: Kazuhito Mita and Keiichi Fujino. Manuscript drafted by: Kazuhito Mita. Revision: Hideto Ito. Statistical advice: Takashi Hayashi. Final approve: Kazuhito Mita and Hideto Ito.
Compliance with Ethical Standards
Conflict of Interest
The authors declare that they have no conflict of interest.