title: Aggressive surgical treatment for T4 gastric cancer.
abstract: Surgical treatment for locally advanced gastric cancer remains controversial, and many still question the benefits of extended resection. The aim of this study was to evaluate the effectiveness of combined resection of the involved organs with regard to survival in patients with gastric cancer. Between 1993 and 2000, among the 1638 patients with gastric cancer who underwent gastrectomy, 82 were found to have evidence of adjacent organ spread at laparotomy. A retrospective analysis of these patients was performed. Curative resections were carried out in 50 patients, whereas noncurative resections were performed in 32 patients. The 5-year survival rate in the group undergoing curative resection was 36.9%. The survival rate in the R0 group was significantly higher than the survival rate for patients undergoing noncurative resections. There was no significant difference in survival rates between patients with pT3 cancer and those with pT4 cancer. Seventy-one patients were pathologically proved to have lymph node metastasis, and the survival rate for patients with a lymph node ratio greater than 0.2 was lower than that in other groups. In multivariate analysis, peritoneal dissemination, lymph node ratio, and histologic findings were the predictors of survival. Patients with T4 gastric carcinoma, even with lymph node metastasis, might have benefited from aggressive surgery with curative intent.
authors.affiliation: Department of Surgery, National Cancer Center Hospital East Japan, Chiba, Japan. akikobay@east.ncc.go.jp
authors.forename: Akihiko
authors.initials: A
authors.lastname: Kobayashi
authors.forename: Toshio
authors.initials: T
authors.lastname: Nakagohri
authors.forename: Masaru
authors.initials: M
authors.lastname: Konishi
authors.forename: Kazuto
authors.initials: K
authors.lastname: Inoue
authors.forename: Shinichirou
authors.initials: S
authors.lastname: Takahashi
authors.forename: Masaaki
authors.initials: M
authors.lastname: Itou
authors.forename: Masanori
authors.initials: M
authors.lastname: Sugitou
authors.forename: Masato
authors.initials: M
authors.lastname: Ono
authors.forename: Norio
authors.initials: N
authors.lastname: Saito
authors.forename: Taira
authors.initials: T
authors.lastname: Kinoshita
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging; D012189:Retrospective Studies; D013274:Stomach Neoplasms / Q000473:pathology / Q000601:surgery*; D015996:Survival Rate