Prognosis of Curatively Resected pT4b Gastric Cancer with Respect to Invaded Organ Type

Min, Jae-Seok; Jin, Sung‐Ho; Park, Sunhoo; Kim, Sang-Bum; Bang, Ho-Yoon; Lee, Jong-Inn

doi:10.1245/s10434-011-1987-6

Cited by 20 publications

(26 citation statements)

References 22 publications

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“…Min et al 16 exclude from the multivisceral resection patients with lymph node metastasis in the para-aortic chain and those who would require associated duodenopancreatectomy. There are also trends in the literature 19 that suggest neoadjuvant treatment, either with chemotherapy or with chemotherapy + radiotherapy, in order to promote tumors' downstaging and to evaluate the biological response -in case of disease progression, patients would be spared from extensive surgery without therapeutic benefit.…”

mentioning

confidence: 99%

Multiorganic resections in gastric cancer

Silva

2017

Rev. Col. Bras. Cir.

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mentioning

confidence: 99%

Multiorganic resections in gastric cancer

Silva

2017

Rev. Col. Bras. Cir.

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“…Although Min et al [16] reported the lowest complication rate of 22% among the reported rates of the previous studies, they also demonstrated one of the highest mortality rates, which was 11%. These results meant that half of the patients who suffered from postoperative complications died; this 50% mortality rate among patients who suffered postoperative morbidity seemed to be a bit high, which was possibly due to the variable definitions of all the complications.…”

Section: Short-term Surgical Outcomesmentioning

confidence: 82%

“…When Buchholtz et al [7] first reported PD for gastric cancer in 1978, they concluded that this treatment should not be performed because of the unacceptable risk without an additional and greater degree of palliation or likelihood of cure; however, they did not discuss their reasons in detail. Several studies have demonstrated short-term surgical outcomes of PD, including intraoperative blood loss, operation time, morbidity, and mortality [ Table 1] [8][9][10][11][12][13][14][15][16][17] . The median amount of blood loss was reported to be > 1000 mL and the median operation time was as long as 7 h.…”

Section: Short-term Surgical Outcomesmentioning

confidence: 99%

“…[14] PD with Min et al . [16] PD death. Nunobe et al [14] featured the largest number of patients, including 31 patients with gastric cancer who underwent PD.…”

Section: Nr Nrmentioning

confidence: 99%

“…However, PD is a highly invasive procedure that cannot be performed on all patients. Since the first reported case of a patient who underwent PD for gastric cancer in 1978 [7] , all case series published [8][9][10][11][12][13][14][15][16][17] were retrospective and single-center studies and no prospective study has been done. Because of the limited number of patients and heterogeneous data of the studies, definite indications for PD have not been established.…”

Section: Introductionmentioning

confidence: 99%

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Pancreaticoduodenectomy for gastric cancer

Makuuchi¹,

Irino²,

Takeda³

et al. 2018

JCMT

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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.

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What determines complications and prognosis among patients subject to multivisceral resections for locally advanced gastric cancer?

Bobrzyński,

Pach,

Szczepanik

et al. 2023

Langenbecks Arch Surg

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Background Locally advanced gastric cancer (GC) extending to the surrounding tissues may require a multivisceral resection (MVR) to provide the best chance of cure. However, little is known about how the extent of organ resection affects the risks and benefits of surgery. Methods An electronic database of patients treated between 1996 and 2020 in an academic surgical centre was reviewed. MVRs were defined as partial or total gastrectomy combined with splenectomy, distal pancreatectomy, or partial colectomy. Results Suspected intraoperative tumour invasion of perigastric organs (cT4b) was found in 298 of 1476 patients with non-metastatic GC, and 218 were subject to MVRs, including the spleen (n = 126), pancreas (n = 51), and colon (n = 41). MVRs were associated with higher proportions of surgical and general complications, but not mortality. A nomogram was developed to predict the risk of major postoperative morbidity (Clavien–Dindo’s grade ≥ 3a), and the highest odds ratio for major morbidity identified by logistic regression modelling was found for distal pancreatectomy (2.53, 95% CI 1.23–5.19, P = 0.012) and colectomy (2.29, 95% CI 1.04–5.09, P = 0.035). Margin-positive resections were identified by the Cox proportional hazards model as the most important risk factor for patients’ survival (hazard ratio 1.47, 95% CI 1.10–1.97). The extent of organ resection did not affect prognosis, but a MVR was the only factor reducing the risk of margin positivity (OR 0.44, 95% CI 0.21–0.87). Conclusions The risk of multivisceral resections is associated with the organ being removed, but only MVRs increase the odds of complete tumour clearance for locally advanced gastric cancer.

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Prognosis of Curatively Resected pT4b Gastric Cancer with Respect to Invaded Organ Type

Cited by 20 publications

References 22 publications

Multiorganic resections in gastric cancer

Multiorganic resections in gastric cancer

Pancreaticoduodenectomy for gastric cancer

What determines complications and prognosis among patients subject to multivisceral resections for locally advanced gastric cancer?

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