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Surgical Impact on Gastric Cancer with Locoregional Invasion

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Abstract

Background

The benefit of resection of gastric cancer with locoregional invasion is still under debate. This study aimed to investigate the impact of surgery on patients with gastric cancer with locoregional invasion.

Methods

From January 1988 to December 2009, a total of 2,678 patients with gastric cancer underwent surgery at the Department of Surgery, Taipei Veterans General Hospital. Among these patients, 569 and 295 were diagnosed as T4a (serosa invasion without penetration of visceral peritoneum) and T4b (serosa exposure with invasion of adjacent structure), respectively. Invasion type and prognosis were analyzed in patients with gastric cancer who had either curative or palliative resection.

Results

Our results showed that patients with T4a gastric cancer had a better 5-year overall survival than patients with T4b (22.5% vs. 11.5%, P < 0.001). Patients with T4b who had curative resection had a better 5-year overall survival than those with T4b who had palliative resection (13.8% vs. 7.3%, P = 0.001). The prognosis of patients with gastric cancer with pancreas invasion was worse than those with mesocolon invasion, as no patients with pancreas invasion survived more than 5 years. Univariate and multivariate analyses showed that tumor size (P = 0.019), Bormann classification (P < 0.001), stromal reaction (P = 0.001), and nodal involvement (P < 0.001) were independent predictors for overall survival in patients with T4b gastric cancer.

Conclusion

Resection of T4b gastric cancer could be performed with curative intent. Patients with gastric cancer with pancreas invasion had a poorer prognosis than those with mesocolon invasion.

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References

  1. Department of Health (2008) Taiwan Public Health Report. Executive Yuan, R.O.C. (Taiwan)

    Google Scholar 

  2. Wu CW, Hsiung CA, Lo SS et al (2006) Nodal dissection for patients with gastric cancer: a randomized controlled trial. Lancet Oncol 7:309–315

    Article  PubMed  CAS  Google Scholar 

  3. Hartgrink HH, van de Velde CJH, Putter H et al (2004) Extended lymph-node dissection for gastric cancer: who may benefit? Final results of the randomized Dutch Gastric Cancer Group Trial. J Clin Oncol 22:2069–2077

    Article  PubMed  CAS  Google Scholar 

  4. Huang KH, Wu CC, Fang WL et al (2010) Palliative resection in noncurative gastric cancer patients. World J Surg 34:1015–1021

    Article  PubMed  Google Scholar 

  5. Martin RC 2nd, Jaques DP, Brennan MF et al (2002) Extended local resection for advanced gastric cancer: increased survival versus increased morbidity. Ann Surg 236:159–165

    Article  PubMed  Google Scholar 

  6. Saito H, Tsujitani S, Maeda Y et al (2001) Combined resection of invaded organs in patients with T4 gastric carcinoma. Gastric Cancer 4:206–211

    Article  PubMed  CAS  Google Scholar 

  7. Kobayashi A, Nakagohri T, Konishi M et al (2004) Aggressive surgical treatment for T4 gastric cancer. J Gastrointest Surg 8:464–470

    Article  PubMed  Google Scholar 

  8. Dhar DK, Kubota H, Tachibana M et al (2001) Prognosis of T4 gastric carcinoma patients: an appraisal of aggressive surgical treatment. J Surg Oncol 76:278–282

    Article  PubMed  CAS  Google Scholar 

  9. Kunisaki C, Akiyama H, Nomura M et al (2006) Surgical outcomes in patients with T4 gastric carcinoma. J Am Coll Surg 202:223–230

    Article  PubMed  Google Scholar 

  10. Carboni F, Lepiane P, Santoro R et al (2005) Extended multiorgan resection for T4 gastric carcinoma: 25-year experience. J Surg Oncol 90:95–100

    Article  PubMed  Google Scholar 

  11. Maehara Y, Oiwa H, Tomisaki S et al (2000) Prognosis and surgical treatment of gastric cancer invading the pancreas. Oncology 59:1–6

    Article  PubMed  CAS  Google Scholar 

  12. Park JH, Hyung WJ, Choi SH et al (2010) Should direct mesocolon invasion be included in T4 for the staging of gastric cancer. J Surg Oncol 101:205–208

    Article  PubMed  Google Scholar 

  13. Ryu SY, Joo JK, Park YK et al (2008) Prognosis of gastric carcinoma invading the mesocolon. Asian J Surg 31:179–184

    Article  PubMed  Google Scholar 

  14. An JY, Ha TK, Noh JH et al (2009) Proposal to subclassify stage IV gastric cancer to IVA, IVB and IVM. Arch Surg 144:38–45

    Article  PubMed  Google Scholar 

  15. Sakuramoto S, Sasako M, Yamaguchi T et al (2007) Adjuvant chemotherapy for gastric cancer with S-1, an oral fluoropyrimidine. N Engl J Med 357:1810–1820

    Article  PubMed  CAS  Google Scholar 

  16. Cunningham D, Rao S, Nicolson M et al (2008) Capecitabine and oxaliplatin for advanced esophagogastric cancer. N Engl J Med 358:36–46

    Article  PubMed  CAS  Google Scholar 

  17. Okines AFC, Norman AR, McCloud C et al (2009) Meta-analysis of the REAL-2 and ML-17032 trials: evaluating capecitabine-based combination chemotherapy and infused 5-fluorouracil-based combination chemotherapy for the treatment of advanced oesophago-gastric cancer. Ann Oncol 20:1529–1534

    Article  PubMed  CAS  Google Scholar 

  18. Koizumi W, Narahara H, Hara T et al (2008) S-1 plus cisplatin versus S-1 alone for first-line treatment of advanced gastric cancer (SPIRITS trial): a phase III trial. Lancet Oncol 9:215–221

    Article  PubMed  CAS  Google Scholar 

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Acknowledgments

This work was supported in part by a grant from the National Science Council of the Republic of China (NSC 99-2628-B-075-001-MY2) and a grant from the Center of Excellence for Cancer Research at Taipei Veterans General Hospital (DOH100-TD-C-111-007).

Conflicts of interest

There are no potential conflicts of interest in this study.

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Authors and Affiliations

  1. Department of Surgery, Taipei Veterans General Hospital, No. 201, Section 2, Shih-Pai Road, Taipei, 11217, Taiwan

    Kuan-Kai Lai, Wen-Liang Fang, Chew-Wun Wu, Kuo-Hung Huang, Jen-Hao Chen & Su-Shun Lo

  2. Department of Pathology, Taipei Veterans General Hospital, Taipei, Taiwan

    Anna Fen-Yau Li

  3. National Yang-Ming University, Taipei, Taiwan

    Kuan-Kai Lai, Chew-Wun Wu, Kuo-Hung Huang, Jen-Hao Chen, Su-Shun Lo & Anna Fen-Yau Li

  4. Institute of Clinical Medicine, National Yang-Ming University, Taipei, Taiwan

    Wen-Liang Fang

Authors
  1. Kuan-Kai Lai
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  2. Wen-Liang Fang
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  3. Chew-Wun Wu
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  4. Kuo-Hung Huang
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Correspondence to Kuo-Hung Huang.

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Lai, KK., Fang, WL., Wu, CW. et al. Surgical Impact on Gastric Cancer with Locoregional Invasion. World J Surg 35, 2479–2484 (2011). https://doi.org/10.1007/s00268-011-1246-9

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  • DOI: https://doi.org/10.1007/s00268-011-1246-9

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