Original scientific article
Surgical Outcomes in Patients with T4 Gastric Carcinoma

https://doi.org/10.1016/j.jamcollsurg.2005.10.020Get rights and content

Background

There is controversy about the best therapeutic surgical approach for treatment of patients with T4 gastric cancer.

Study design

We used univariate and multivariate analyses to review the surgical outcomes and prognostic factors of 117 patients who underwent surgery for T4 gastric carcinoma.

Results

Curative resection was performed in 38 (32.4%) patients, with the pancreas being the most frequently resected organ. The 5-year survival rate was 16.0% and the median survival time (MST) was 11 months for all 117 registered patients. The 5-year survival rates and MSTs in patients after curative and noncurative resection were 32.2% versus 9.5% and 20 months versus 8 months, respectively. These values differed considerably between the two groups (p < 0.0001). Curability was an independent prognostic factor among all registered patients, including those who underwent noncurative resection. A relatively small tumor diameter (< 100 mm) and few lymph node metastases (six or fewer metastatic lymph nodes) were independent prognostic factors when curative resection could be performed. Postoperative morbidity and mortality were acceptable after curative combined resection.

Conclusions

We recommend the use of aggressive combined resection of adjacent organs, with extended lymph node dissection, for patients with T4 gastric carcinoma in whom curative resection can be used; that is, those with few metastatic lymph nodes (six or less) and a relatively small tumor diameter (100 mm). But noncurative resection should be avoided in patients with T4 gastric cancer.

Section snippets

Methods

Between April 1994 and December 1999, 1,959 patients with histologically proved gastric cancer underwent surgical resection at the Department of Gastroenterological Surgery, Yokohama City University, Yokohama, Japan, and its satellite institutions. From this group, 117 individuals (6.0%) with histologically proved T4 gastric carcinoma were selected for inclusion in this study. Data were retrieved from operative and pathologic reports, and followup data were obtained from the outpatient clinical

Organs invaded by the tumors

The organs invaded by the tumors are listed in Table 1. The pancreas was the most frequently invaded organ. Multiple organs were invaded by the tumors in 15 patients.

Combined resection

In the 38 patients receiving curative resection, the pancreas was the most frequently resected organ, with pancreaticosplenectomy being performed in 17 patients. In the 79 patients who underwent noncurative resection, the most frequently performed procedure was resection of the transverse colon or mesocolon, which was undertaken in

Discussion

This study revealed that when the tumor was of a relatively small diameter (< 100 mm) and lymph node metastasis was limited (≤ 6 metastatic lymph nodes), curative resection provided good surgical results in T4 gastric carcinoma patients. There were acceptable postoperative morbidities with no fatal complications after curative combined resection in these patients.

But T4 gastric cancer is often less easily cured.3, 4 Uncontrollable secondary factors, including peritoneal, liver, and distant

References (18)

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Copyright © 2006 American College of Surgeons. Published by Elsevier Inc. All rights reserved.