Pancreaticoduodenectomy for gastric cancer

Abstract

Pancreaticoduodenectomy (PD) is performed to achieve an R0 resection for gastric cancer with pancreatic and/or duodenal invasion. Several retrospective case series have been published, but the sample cohorts in each study were heterogeneous and small. Moreover, the absence of prospective studies results in a lack of solid evidence that will help determine who can benefit from this procedure. Although the morbidity and mortality of PD have been reported by most studies to be acceptable and that the procedure is feasible, these remained to be much higher than those of standard gastrectomy. Therefore, careful selection of patients should be considered. Based on a review of previous case series and our own experience, PD appears to be beneficial to patients with gastric cancer with pancreatic invasion when R0 resection is possible. In addition, multidisciplinary treatment such as neoadjuvant chemotherapy, is anticipated to improve survival. Nevertheless, considering that prospective randomized studies are difficult to perform, a large-scale multicenter retrospective cohort study is required to evaluate this highly invasive procedure.

Аre Multivisceral Resections for Gastric Cancer Acceptable: Experience from a High Volume Center and Extended Literature Review?

“…6 The mainstay in managing locally advanced gastric carcinoma is radical surgery, with R0 multivisceral resection (MVR) being the only potentially curative treatment. 7,8…”

“…The mainstay in managing locally advanced gastric carcinoma is radical surgery, with R0 multivisceral resection (MVR) being the only potentially curative treatment. 7 8 The Japanese Gastric Cancer Association 9 and National Comprehensive Cancer Network 10 recommend extensive resections of adjacent organs for T4b when negative margins are possible, while the European Society for Medical Oncology 11 advises neoadjuvant therapy. In addition, the achievement of R0 resection remains the most powerful predictor of long-term outcomes in patients who have undergone radical surgery for advanced gastric carcinoma.…”

Introduction to the special issue on reviews of gastric cancer metastasis and treatment

“…However, the efficacy and safety of PD for advanced gastric cancer remain unclear. Makuuchi et al [15] reviewed the literatures on PD for gastric cancer and their own experience.…”