Outcome of D2 Gastrectomy with Combined Resection of Invaded Adjacent Organs in Patients with T4 Gastric Carcinoma: 10-Year Experience
Abstract
Background: The surgical management of locally advanced gastric carcinoma with invasion to adjacent organs (T4) remains controversial and many still question the benefit of a combined resection with D2 gastrectomy.
Objectives: The aim of this study was to examine the morbidity and mortality associated with combined resection with D2 gastrectomy and also to determine the survival benefit.
Patients and Methods: Between October 1995 and September 2005, 11 patients had resection with curative intent for T4 gastric carcinoma invading adjacent organs. Clinicopathologic features, morbidity, mortality and survival outcome were reviewed. Independent prognostic factors for gastric carcinoma were evaluated by multivariate analysis.
Results: Undifferrentiated tumor was reported in 72.7%. Angiolymphatic invasion was presented in 90.9%. Positive cytology was found in 72.7%. Nodal involvement was presented in all patients. Organs most commonly resected with the stomach were the pancreas, followed by transverse colon and left lobe of liver. Complications occurred in 45.4%. There was no operative mortality. The 5-year overall survival rate for T4 compared with T1-3 gastric carcinoma were 16% and 65%, respectively. One patient (9.1%) survives longer than 7 years after surgery.
Conclusions: Patients with locally advanced gastric carcinoma invading adjacent organs (T4) may benefit from aggressive en bloc combined resection with D2 gastrectomy if curative resection can be performed. This procedure can be performed with acceptable morbidity, no mortality, and long term survival could be achieved. But noncurative resection should be avoided in patients with T4 gastric carcinoma.
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