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Annals of Surgical Oncology

, Volume 22, Supplement 3, pp 840–847 | Cite as

Multivisceral Resection for Gastric Cancer: Results from the US Gastric Cancer Collaborative

  • Thuy B. Tran
  • David J. Worhunsky
  • Jeffrey A. Norton
  • Malcolm Hart SquiresIII
  • Linda X. Jin
  • Gaya Spolverato
  • Konstantinos I. Votanopoulos
  • Carl Schmidt
  • Sharon Weber
  • Mark Bloomston
  • Clifford S. Cho
  • Edward A. Levine
  • Ryan C. Fields
  • Timothy M. Pawlik
  • Shishir K. Maithel
  • George A. Poultsides
Gastrointestinal Oncology

Abstract

Background

Resection of an adjacent organ during gastrectomy for gastric cancer is occasionally necessary to achieve margin clearance. The short- and long-term outcomes of this approach remain unclear.

Methods

Patients who underwent gastric cancer resection in seven U.S. academic institutions from 2000 to 2012 were evaluated to compare perioperative morbidity, mortality, and survival outcomes, stratified by the need for and type of multivisceral resection (MVR).

Results

Of 835 patients undergoing curative-intent gastrectomy, 159 (19 %) had MVR. The most common adjacent organs resected were the spleen (48 %), pancreas (27 %), liver segments 2/3 (14 %), and colon (13 %). As extent of resection increased (gastrectomy only, n = 676; MVR without pancreatectomy, n = 116; and MVR with pancreatectomy, n = 43), perioperative morbidity was higher: any complication (45, 60, 59 %, p = 0.012), major complication (17, 31, 33 %, p = 0.001), anastomotic leak (5, 11, 19 %, p < 0.001), and respiratory failure (9, 15, 22 %, p = 0.012). However, perioperative mortality did not significantly increase (30-day: 3, 4, 2 %, p = 0.74; 90-day: 6, 8, 9 %, p = 0.61). Overall survival after resection decreased as extent of resection increased (5-year: 42, 28, 6 %). After controlling for age, race, T stage, N stage, grade, margin status, perineural invasion, adjuvant therapy, and blood transfusion, MVR with pancreatectomy (HR 1.67, p = 0.044), but not MVR without pancreatectomy (HR 0.97, p = 0.759), remained an independent predictor of poor survival.

Conclusion

In this modern, multi-institutional cohort of gastric cancer patients, multivisceral resection was associated with higher perioperative morbidity but not significantly higher perioperative mortality. If concomitant pancreatectomy is anticipated, patients should be selected with extreme caution because long-term survival remains poor.

Keywords

Gastric Cancer Gastric Adenocarcinoma Distal Pancreatectomy Adjacent Organ Gastric Cancer Resection 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.

Notes

Disclosure

There are no conflicts of interest.

Supplementary material

10434_2015_4694_MOESM1_ESM.tiff (4.1 mb)
An exploratory analysis of various MVR combinations demonstrated poorer survival with any pancreatectomy, whereas similar survival rates were observed in patients who underwent different combinations of MVR without pancreatectomy. Supplementary material 1 (TIFF 4221 kb)

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Copyright information

© Society of Surgical Oncology 2015

Authors and Affiliations

  • Thuy B. Tran
    • 1
  • David J. Worhunsky
    • 1
  • Jeffrey A. Norton
    • 1
  • Malcolm Hart SquiresIII
    • 2
  • Linda X. Jin
    • 3
  • Gaya Spolverato
    • 4
  • Konstantinos I. Votanopoulos
    • 5
  • Carl Schmidt
    • 6
  • Sharon Weber
    • 7
  • Mark Bloomston
    • 6
  • Clifford S. Cho
    • 7
  • Edward A. Levine
    • 5
  • Ryan C. Fields
    • 3
  • Timothy M. Pawlik
    • 4
  • Shishir K. Maithel
    • 2
  • George A. Poultsides
    • 1
  1. 1.Department of Surgery, Stanford Cancer InstituteStanford UniversityStanfordUSA
  2. 2.Department of Surgery, Winship Cancer InstituteEmory UniversityAtlantaUSA
  3. 3.Department of Surgery, Barnes Jewish Hospital and The Alvin J. Siteman Cancer CenterWashington UniversitySt. LouisUSA
  4. 4.Department of SurgeryThe Johns Hopkins UniversityBaltimoreUSA
  5. 5.Department of SurgeryWake Forest UniversityWinston-SalemUSA
  6. 6.Department of SurgeryThe Ohio State UniversityColumbusUSA
  7. 7.Department of SurgeryUniversity of WisconsinMadisonUSA

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