Short-term safety and Long-term efficacy of multivisceral resection in pT4b gastric cancer patients without distant metastasis: a 20-year experience in China National Cancer Center

Abstract

Background: Multivisceral resection is occasionally necessary for pT4b gastric cancer patients to achieve negative margin. The purpose of this study is to assess the short-term safety and long-term efficacy of this approach. Methods: A single-center, retrospective analysis was conducted for pT4b gastric cancer patients after curative-intent multivisceral resection from the China National Cancer Center Gastric Cancer Database (NCCGCDB) from 1998 to 2018. The postoperative complications, recurrence patterns, long-term survival, and prognostic factors were analyzed. Results: A total of 210 patients were included in the study. The most common combined resection organs were multiple organs (30.5%), pancreas (20.5%), colon (16.7%), and liver (9.0%). Seventeen patients (8.1%) developed postoperative complications and hospital death was observed in one patient (0.5%). The most common postoperative complications were anastomotic leak (4.3%) and intra-abdominal infection (5.7%). The 3-year and 5-year disease-free survival (DFS) rates for the patients investigated were 38.0% and 33.8%, respectively, and the 3-year and 5-year overall survival (OS) rates were 48.2% and 39.1%, respectively. Multivariate Cox regression analysis proved that negative nerve invasion was independent risk factors for DFS (HR: 2.202, 95%CI: 1.144-4.236, P =0.018) and OS (HR: 2.219, 95%CI: 1.164-4.231, P =0.015). Conclusions: Multivisceral resection in pT4b gastric cancer patients without distant metastasis was effective and had an acceptable safety profile.

Analysis of Patient Outcomes following Curative R0 Multiorgan Resections for Locally Advanced Gastric Cancer: A Systematic Review and Meta-Analysis

“…Japan emerged as a significant contributor to the literature on this topic, with multiple studies spanning over a decade (Dhar et al [21], Kobayashi et al [22], Kunisaki et al [23], Mita et al [29], Mita et al [33]), reflecting a sustained interest and expertise in the surgical management of locally advanced gastric cancer within the country. These studies, alongside those from China (Wang et al [26], Xiao et al [31], Xiao et al [34], Yang et al [35], Zhang et al [38]), South Korea (Kim et al [25], Jeong et al [27]), and Italy (Carboni et al [24], Pacelli et al [30], Aversa et al [37]), provide a comprehensive insight into the practice patterns, surgical outcomes, and evolving trends in the management of this disease across different healthcare settings and populations. The quality of the studies varied, with a notable distinction between retrospective and prospective designs.…”

“…A total of 2310 articles were identified according to the initial search, of which 426 duplicate entries were eliminated, 1569 records were excluded before screening based on title and abstract, and 295 articles were excluded after full read for not matching the inclusion criteria or having no available data. The systematic review included a total of 20 studies in the final analysis [21][22][23][24][25][26][27][28][29][30][31][32][33][34][35][36][37][38][39][40], delineated in Figure 1, spanning a period from 2001 to 2023, with a geographical distribution across Asia (Japan, South Korea, China, Taiwan), Europe (Italy, Poland, Bulgaria), and South America (Brazil). The studies predominantly employed retrospective cohort designs, with seven studies (Carboni et al [24], Jeong et al [27], Cheng et al [28], Li et al [32], Mita et al [33], Aversa et al [37], and Zhang et al [38]) utilizing prospective cohort approaches, indicating a varied methodological approach to investigating survival rates in R0 curative resections following multiorgan resection for locally advanced gastric cancer.…”

“…The quality of the studies varied, with a notable distinction between retrospective and prospective designs. Prospective cohorts from Italy (Carboni et al [24], Pacelli et al [30], Aversa et al [37]), Taiwan (Cheng et al [28]), South Korea (Jeong et al [27]), and China (Li et al [32], Zhang et al [38]) were generally rated high in quality, reflecting the rigorous data collection and follow-up processes inherent in prospective research. Conversely, retrospective cohorts predominantly received medium quality ratings, except for a few from South Korea (Kim et al [25]) and China (Wang et al [26], Xiao et al [31]), which were rated low.…”

Multivisceral Oncological Resections Involving the Pancreas: Protocol for a Systematic Review and Meta-Analysis

“…Among abdominal tumors in locally advanced stages such as sarcomas, colon cancer, pancreatic cancer, and gastric cancer, the organs most frequently subjected to resection encompass the colon, gallbladder, stomach, liver, kidney, and notably, the pancreas [ 1 , 3 , 5 , 6 ]. While isolated pancreatic operations are acknowledged as intricate interventions bearing considerable risks, including considerable mortality and morbidity rates [ 2 , 4 ], a noteworthy proportion of patients, roughly one-third, undergo pancreatic resection as part of a multivisceral resection [ 7 ].…”

“…While isolated pancreatic operations are acknowledged as intricate interventions bearing considerable risks, including considerable mortality and morbidity rates [ 2 , 4 ], a noteworthy proportion of patients, roughly one-third, undergo pancreatic resection as part of a multivisceral resection [ 7 ]. If oncological multivisceral resections include high risk interventions such as a pancreas resection, this can be associated with an additional increase in complication rates [ 2 , 3 , 5 , 8 ].…”