Extended multiorgan resection for T4 gastric carcinoma: 25-year experience.
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.
Carboni
Fabio
F
Department of Digestive Surgery and Liver Transplantation, Regina Elena Cancer Institute, Rome, Italy. fabiocarb@tiscali.it
Lepiane
Pasquale
P
Santoro
Roberto
R
Lorusso
Riccardo
R
Mancini
Pietro
P
Sperduti
Isabella
I
Carlini
Massimo
M
Santoro
Eugenio
E
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