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

Abstract

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.

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

“…Kobayashi et al [22], for instance, detailed a comprehensive range of additional surgeries, including pancreatectomy and splenectomy in 43.9% of cases, showcasing the complexity of surgical management in these patients. Complication rates varied widely across the studies, with post-operative complications ranging from as low as 9.6% in Xiao et al [34] to as high as 75% in Bobrzy ński et al [39], indicating the high-risk nature of these extensive surgical procedures. Post-operative death rates also varied, underscoring the serious risk associated with such aggressive treatment approaches.…”

“…Complication rates varied widely across the studies, with post-operative complications ranging from as low as 9.6% in Xiao et al [34] to as high as 75% in Bobrzyński et al [39], indicating the high-risk nature of these extensive surgical procedures. Post-operative death rates also varied, underscoring the serious risk associated with such aggressive treatment approaches.…”

“…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.…”

“…Japan emerged as a significant contributor to the literature on this topic, with multiple studies spanning over a decade (Dhar et [36], Bobrzyński et al [39], Vladov et al [40]) suggests a reliance on existing medical records and databases for data collection, which, while practical for large sample sizes and long-term outcomes, may introduce recall or selection biases. The prospective cohorts (Carboni et al [24], Jeong et al [27], Cheng et al [28], Li et al [32], Mita et al [33], Aversa et al [37], Zhang et al [38]), however, provide a more controlled observation of patient outcomes over time, contributing valuable longitudinal data on survival rates post-multiorgan resection, as presented in Table 1.…”

“…The advanced stage of disease in patients, primarily those with T4 gastric carcinoma, necessitates multiorgan resections, including pancreatectomy, splenectomy, and liver resection, to attempt R0 status. The notable incidence of post-operative complications, reported as high as 75% in some studies [39], underscores the significant morbidity risk these extensive procedures carry. However, it depends on how the complications are assessed and measured, as the included studies date back to as far as 2001 [21], and standardized classifications such as the Clavien-Dindo scale were not yet developed or largely accepted [42].…”