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

Abstract

Introduction Multivisceral resections (MVRs) in gastric cancer are potentially curable in selected patients in whom clear resection margins are possible. However, there are still uncertain data on their feasibility and safety considering short- and long-term results. The study compares survival, morbidity, mortality, and other secondary outcomes between standard and MVRs for gastric cancer. Materials and Methods A monocentric retrospective study in patients with gastric adenocarcinoma, covering 2004 to 2020. Of the 336 operable cases, 101 patients underwent MVRs. The remaining 235 underwent standard gastric resections (SGRs), of which 173 patients were in stage T3/T4. To compare survival, a control group of 101 patients with palliative procedures was used—bypass anastomosis or exploration. Results MVR had a lower survival rate than the SGR but significantly higher than the palliative procedures. The predominant gender in MVR was male (72.3%), with a mean age of 61 years. The perioperative mortality was 3.96% (n = 4), and the overall median survival was 28.1 months. The most frequently resected organs were the spleen (67.3%), followed by the pancreas (32.7%) and the liver (20.8%). In 56.4% of the cases two organs were resected, in 28.7% three organs, and in 13.9% four organs. The main complication was bleeding (9.9%). The major postoperative complications in the MVR were 14.85%, and in the SGR 6.4% (p < 0.05). Better long-term results were observed in patients who underwent R0 resections compared with R1. Conclusion Multiorgan resections are characterized by poorer survival and a higher complication rate than gastrectomies. On the other hand, they have better long-term outcomes than palliative procedures. However, MVRs are admissible when performed by an experienced surgical team in high-volume centers.

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

“…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 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. 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.…”

“…It was observed among studies that even though R0 status was achieved, lymph node involvement was a determining factor for survival. As such, N3 lymph node involvement and as low as 6-7 positive nodes were considered significant worsening factors for survival in many of the analyzed studies [23,25,27,28,30,32,33,35,36,40].…”