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Journal of Gastrointestinal Surgery

, Volume 21, Issue 12, pp 1993–1999 | Cite as

Prognostic Factors Affecting Survival After Multivisceral Resection in Patients with Clinical T4b Gastric Cancer

  • Kazuhito Mita
  • Hideto Ito
  • Toshio Katsube
  • Ayaka Tsuboi
  • Nobuyoshi Yamazaki
  • Hideki Asakawa
  • Takashi Hayashi
  • Keiichi Fujino
Original Article
  • 174 Downloads

Abstract

Background

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.

Methods

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.

Results

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.

Conclusions

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.

Keywords

T4 gastric cancer Prognostic factors Multivisceral resection Complete resection 

Notes

Author Contribution

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.

References

  1. 1.
    Sano T, Sasako M, Yamamoto S, et al. Gastric cancer surgery: morbidity and mortality results from a prospective randomized controlled trial comparing D2 and extended para-aortic lymphadenectomy—Japan Clinical Oncology Group study 9501. J Clin Oncol. 2004; 22:2767–2773.CrossRefPubMedGoogle Scholar
  2. 2.
    Shchepotin IB, Chorny VA, Nauta RJ, et al. Extended surgical resection in T4 gastric cancer. Am J Surg 1998; 175:123–126.CrossRefPubMedGoogle Scholar
  3. 3.
    Kim JH, Jang YJ, Park SS, et al. Surgical outcomes and prognostic factors for T4 gastric cancers. Asian J Surg 2009; 32:198–204.CrossRefPubMedGoogle Scholar
  4. 4.
    Isozaki H, Tanaka N, Tanigawa N, et al. Prognostic factors in patients with advanced gastric cancer with macroscopic invasion to adjacent organs treated with radical surgery. Gastric Cancer 2000; 3:202–210.CrossRefPubMedGoogle Scholar
  5. 5.
    Martin RC, Jaques DP, Brennan MF, et al. Achieving RO resection for locally advanced gastric cancer: is it worth the risk of multiorgan resection? J Am Coll Surg 2002; 194:568–577.CrossRefPubMedGoogle Scholar
  6. 6.
    Nanthakumaran S, Fernandes E, Thompson AM, et al. Morbidity and mortality rates following gastric cancer surgery and contiguous organ removal, a population based study. Eur J Surg Oncol 2005; 31:1141–1144.CrossRefPubMedGoogle Scholar
  7. 7.
    Kunisaki C, Miyata H, Konno H, et al. Modeling preoperative risk factors for potentially lethal morbidities using a nationwide Japanese web-based database of patients undergoing distal gastrectomy for gastric cancer. Gastric Cancer 2017; 20:496–507CrossRefPubMedGoogle Scholar
  8. 8.
    Brar SS, Seevaratnam R, Cardoso R, et al. Multivisceral resection for gastric cancer: a systematic review. Gastric Cancer 2012; 15 Suppl 1: S100–107.CrossRefPubMedGoogle Scholar
  9. 9.
    Pacelli F, Cusumano G, Rosa F, et al. Multivisceral resection for locally advanced gastric cancer: an Italian multicenter observational study. JAMA Surg. 2013; 148:353–360.CrossRefPubMedGoogle Scholar
  10. 10.
    Cheng CT, Tsai CY, Hsu JT, et al. Aggressive surgical approach for patients with T4 gastric carcinoma: promise or myth? Ann Surg Oncol 2011; 18:1606–1614.CrossRefPubMedGoogle Scholar
  11. 11.
    Kim DY, Joo JK, Seo KW, et al. T4 gastric carcinoma: the benefit of non-curative resection. ANZ J Surg 2006; 76:453–457.CrossRefPubMedGoogle Scholar
  12. 12.
    Ozer I, Bostanci EB, Orug T, et al. Surgical outcomes and survival after multiorgan resection for locally advanced gastric cancer. Am J Surg 2009; 198:25–30.CrossRefPubMedGoogle Scholar
  13. 13.
    Li MZ, Deng L, Wang JJ, et al. Surgical outcomes and prognostic factors of T4 gastric cancer patients without distant metastasis. PLoS One 2014; 9:e107061.CrossRefPubMedPubMedCentralGoogle Scholar
  14. 14.
    Dhar DK, Kubota H, Tachibana M, et al. Prognosis of T4 gastric carcinoma patients: an appraisal of aggressive surgical treatment. J Surg Oncol 2001; 76:278–282.CrossRefPubMedGoogle Scholar
  15. 15.
    Martin RC, Jaques DP, Brennan MF, et al. Extended local resection for advanced gastric cancer: increased survival versus increased morbidity. Ann Surg 2002; 236:159–165.CrossRefPubMedPubMedCentralGoogle Scholar
  16. 16.
    Kobayashi A, Nakagohri T, Konishi M, et al. Aggressive surgical treatment for T4 gastric cancer. J Gastrointest Surg 2004; 8:464–470.CrossRefPubMedGoogle Scholar
  17. 17.
    Carboni F, Lepiane P, Santoro R, et al. Extended multiorgan resection for T4 gastric carcinoma: 25-year experience. J Surg Oncol 2005; 90:95–100.CrossRefPubMedGoogle Scholar
  18. 18.
    Kunisaki C, Akiyama H, Nomura M, et al. Surgical outcomes in patients with T4 gastric carcinoma. J Am Coll Surg 2006; 202:223–230.CrossRefPubMedGoogle Scholar
  19. 19.
    Jeong O, Choi WY, Park YK. Appropriate selection of patients for combined organ resection in cases of gastric carcinoma invading adjacent organs. J Surg Oncol 2009; 100:115–120.CrossRefPubMedGoogle Scholar
  20. 20.
    Kasakura Y, Fujii M, Mochizuki F, et al. Is there a benefit of pancreaticosplenectomy with gastrectomy for advanced gastric cancer? Am J Surg 2000; 179:237–242.CrossRefPubMedGoogle Scholar
  21. 21.
    Colen KL, Marcus SG, Newman E, et al. Multiorgan resection for gastric cancer: intraoperative and computed tomography assessment of locally advanced disease is inaccurate. J Gastrointest Surg 2004; 8:899–902.CrossRefPubMedGoogle Scholar

Copyright information

© The Society for Surgery of the Alimentary Tract 2017

Authors and Affiliations

  • Kazuhito Mita
    • 1
  • Hideto Ito
    • 1
  • Toshio Katsube
    • 1
  • Ayaka Tsuboi
    • 1
  • Nobuyoshi Yamazaki
    • 1
  • Hideki Asakawa
    • 1
  • Takashi Hayashi
    • 1
  • Keiichi Fujino
    • 1
  1. 1.Department of SurgeryNew Tokyo HospitalMatudoJapan

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