Prognosis and Surgical Treatment of Gastric Cancer Invading the Pancreas

Abstract

The clinicopathologic characteristics of gastric cancer invading the pancreas have not been determined. Gastrectomy was performed in 282 patients with gastric cancer invading adjacent organs at the Department of Surgery II, Kyushu University Hospital, between 1970 and 1987, and patient data were retrospectively analyzed using univariate and multivariate analyses. Of these patients, 150 (53.2%) had tumors invading the pancreas and 132 had tumors invading adjacent organs other than the pancreas. In both groups, the undifferentiated tissue type with infiltrative growth, lymphatic involvement and lymph node metastasis was common. In cases of pancreas invasion, the extent of lymph node metastasis was more severe, vascular involvement was more frequent and the rate of concomitant liver metastasis was higher. The survival time of the patients with pancreas invasion was shorter compared to patients with cancer invading other organs, and pancreas involvement was one of the independent factors predicting a poor prognosis. With respect to surgical treatment of gastric cancer invading the pancreas, the prognosis was better for cases treated with curative surgery and pancreas resection. Of 39 patients treated with partial resection of the pancreas, the tumor had invaded only the capsule of the pancreas in 18 and the pancreas in the other 21. Pancreas-invasive gastric cancer cells are likely to advance via lymphatic and vascular routes and survival time is shorter, but curative resection can improve the survival rate, and perioperative treatment should be appropriately designed.

Pancreaticoduodenectomy for advanced gastric cancer

“…Such patients, theoretically, could have avoided this procedure; however, inconsistency between macroscopic and microscopic findings of infiltration has been reported to be 30%-50%, often because of inflammatory reactions surrounding the tumor [8,12]. Even if the latest diagnostic modalities, such as computed tomography (CT), magnetic resonance imaging (MRI), and endoscopic ultrasound (EUS) are used, it is very difficult to distinguish between inflammatory reactions and tumor infiltration before operation.…”

Recurrence of gastric cancer invading the main pancreatic duct: A case report

“…The intraductal invaded cancer cells grew and finally packed the pancreatic duct. Maehara et al [7] classified pancreatic invasion of gastric cancer into three types: invasion only to the pancreatic capsule, invasion to the capsule and interlobular tissues, and invasion to the capsule and intralobular tissues. It has been reported that the degree of serosal invasion and lymphovascular invasion may be associated with locoregional recurrence [8].…”

A systematic review of spleen and pancreas preservation in extended lymphadenectomy for gastric cancer

“…However, indications for splenectomy and Significance corresponds to the noted superscripts AL anastomotic leakage, N number, NR not reported, NS not significant, PD pancreaticoduodenectomy, PF pancreatic fistula, PP pancreaspreserving, PR pancreaticosplenectomy, pts patients, R0 resection with no residual tumor, SP spleen-preserving, SR splenectomy pancreatectomy in several of the articles included both extended lymphadenectomy and direct invasion [16,17,37,41,43,47,48]. Margin status is a strong prognostic indicator in patients undergoing surgery for gastric cancer, and positive margins are associated with decreased survival [14,42,45]. Accordingly, resections of the spleen and/or Significance corresponds to the noted superscripts AL anastomotic leakage, CG conventional gastrectomy, CL chylous leak, met presence of metastasis, MS median survival, N number, NR not reported, NS not significant, PF pancreatic fistula, PP pancreas-preserving, PR pancreaticosplenectomy, pts patients, R0 resection with no residual tumor, SP spleen-preserving, SR splenectomy pancreas in cases where direct invasion is suspected, in the absence of metastatic disease, may be treated with multivisceral resection [12,14,19,42,43,45], though some argue that survival may not be improved with an aggressive surgical approach [21].…”

“…Margin status is a strong prognostic indicator in patients undergoing surgery for gastric cancer, and positive margins are associated with decreased survival [14,42,45]. Accordingly, resections of the spleen and/or Significance corresponds to the noted superscripts AL anastomotic leakage, CG conventional gastrectomy, CL chylous leak, met presence of metastasis, MS median survival, N number, NR not reported, NS not significant, PF pancreatic fistula, PP pancreas-preserving, PR pancreaticosplenectomy, pts patients, R0 resection with no residual tumor, SP spleen-preserving, SR splenectomy pancreas in cases where direct invasion is suspected, in the absence of metastatic disease, may be treated with multivisceral resection [12,14,19,42,43,45], though some argue that survival may not be improved with an aggressive surgical approach [21]. Importantly, it is clear that resection of the spleen and pancreas for direct invasion should be considered separately from extended lymphadenectomy with spleen and pancreas preservation.…”

“…Extended lymphadenectomy with spleen resection for patients was associated with decreased survival in one study compared to spleen preservation when these nodes were positive [44]. R0 resection was associated with improved survival in patients in two studies [14,42].…”