title: Extended multiorgan resection for T4 gastric carcinoma: 25-year experience.
abstract: OBJECTIVE
  In locally advanced gastric carcinoma infiltrating adjacent organs, an extended resection including invaded organs is required to improve the prognosis. We retrospectively analyzed our experience with extended multiorgan resection (EMR) in patients with advanced gastric cancer.
  
  
  METHODS
  Between December 1979 and April 2004, 65 patients were resected for extended gastric carcinoma macroscopically invading other organs. Various clinicopathologic factors influencing early and late results were evaluated. Survival rates were calculated according to the Kaplan-Meier method. Prognostic factors were evaluated by univariate and multivariate analysis.
  
  
  RESULTS
  The majority of patients (61.5%) did receive a R0 curative resection. In 52 (80%) of the 65 presumed T4 cancers, histologic final analysis confirmed invasion. Postoperative morbidity and mortality was 27.7% and 12.3%, respectively. Actuarial 5-year overall survival (OS) rate was 21.8%. It was significantly better in R0 versus R+ (30.6% vs. 0%, P = 0.001). Multivariate analysis identified curative resection as the strongest predictor of survival (P = 0.002).
  
  
  CONCLUSIONS
  Patients with locally advanced gastric carcinoma invading adjacent organs can benefit from aggressive surgical treatment with acceptable morbidity and mortality. However, curative resection is mandatory to improve prognosis.
authors.affiliation: Department of Digestive Surgery and Liver Transplantation, Regina Elena Cancer Institute, Rome, Italy. fabiocarb@tiscali.it
authors.forename: Fabio
authors.initials: F
authors.lastname: Carboni
authors.forename: Pasquale
authors.initials: P
authors.lastname: Lepiane
authors.forename: Roberto
authors.initials: R
authors.lastname: Santoro
authors.forename: Riccardo
authors.initials: R
authors.lastname: Lorusso
authors.forename: Pietro
authors.initials: P
authors.lastname: Mancini
authors.forename: Isabella
authors.initials: I
authors.lastname: Sperduti
authors.forename: Massimo
authors.initials: M
authors.lastname: Carlini
authors.forename: Eugenio
authors.initials: E
authors.lastname: Santoro
mesh_terms: D000328:Adult; D000368:Aged; D005260:Female; D005743:Gastrectomy / Q000379:methods*; D006801:Humans; D008197:Lymph Node Excision; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D009361:Neoplasm Invasiveness; D009367:Neoplasm Staging; D010180:Pancreatectomy; D011379:Prognosis; D012189:Retrospective Studies; D013156:Splenectomy; D013274:Stomach Neoplasms / Q000401:mortality / Q000473:pathology* / Q000601:surgery*; D015996:Survival Rate