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Extended Gastrectomy for T4b Gastric Adenocarcinoma: Single-Surgeon Experience

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Abstract

Purpose

This study reports single-surgeon experience with extended gastrectomy including en-bloc resection of adjacent organs/structures for T4b stage gastric adenocarcinoma. Time-related changes in patient selection criteria and outcomes were also analyzed.

Methods

All consecutive gastrectomies for adenocarcinoma performed between May 2004 and December 2017 were extracted from prospectively collected database to study surgical and oncologic results. Time-related changes in outcomes were examined according to three time periods.

Results

Five hundred eighty-seven gastrectomies were performed throughout the study period including 87 (14.8%) extended resections. The latter most often included pancreatosplenectomy, colon, and liver resections (21, 16, and 11 patients, respectively) resulting in similar postoperative outcomes and survival. Extended gastrectomy was associated with larger tumor size (8.4 vs 5.6 cm), performing total gastrectomy (55.2 vs 35.2%, p < 0.01) and increased blood loss (375 vs 150 ml, p < 0.01) compared with standard gastrectomy. Larger experience in extended gastrectomy allowed for expanding patient selection criteria, considering complex resections and extensive lymphadenectomy. Median and 3-year survival following extended gastrectomy for T4b adenocarcinoma were 14 months and 18%, respectively, which was comparable to standard gastrectomy for T4a adenocarcinoma (p = 0.48). Obesity, nodal stage and type of gastrectomy were associated with survival in T4b adenocarcinoma in the univariable analysis. Obesity and N3a and N3b stages were independent predictors in the multivariable model.

Conclusions

Extended gastrectomy for T4b gastric adenocarcinoma provides satisfactory surgical outcomes even with expanded patient selection criteria and regardless of the organ involved. Given its poor prognosis, neoadjuvant therapy should be considered to improve the long-term oncologic results.

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Authors and Affiliations

  1. Department of Surgery N1, Yerevan State Medical University after M.Heratsi, Yerevan, Armenia

    Mushegh А. Sahakyan & Arthur M. Sahakyan

  2. Department of General and Laparoscopic Surgery, Central Clinical Military Hospital, Yerevan, Armenia

    Mushegh А. Sahakyan & Sevak S. Shahbazyan

  3. Department of General and Abdominal Surgery, ArtMed MRC, Yerevan, Armenia

    Artak Gabrielyan, Hmayak Petrosyan & Arthur M. Sahakyan

  4. Department of Anesthesiology and Intensive Care, ArtMed MRC, Yerevan, Armenia

    Shushan Yesayan

  5. Department of Anesthesiology and Intensive Care, Yerevan State Medical University after M. Heratsi, Yerevan, Armenia

    Shushan Yesayan

  6. Department of General and Thoracic Surgery, Yerevan State Medical University after M.Heratsi, Yerevan, Armenia

    Sevak S. Shahbazyan

Authors
  1. Mushegh А. Sahakyan
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  2. Artak Gabrielyan
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  3. Hmayak Petrosyan
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  4. Shushan Yesayan
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  5. Sevak S. Shahbazyan
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  6. Arthur M. Sahakyan
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Corresponding author

Correspondence to Mushegh А. Sahakyan.

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The study was approved by the local institutional data protection officers. Written informed consent was waived due to the retrospective study design.

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The authors declare that they have no conflict of interest.

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Sahakyan, M.А., Gabrielyan, A., Petrosyan, H. et al. Extended Gastrectomy for T4b Gastric Adenocarcinoma: Single-Surgeon Experience. J Gastrointest Canc 51, 135–143 (2020). https://doi.org/10.1007/s12029-019-00222-z

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  • DOI: https://doi.org/10.1007/s12029-019-00222-z

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