Selection of best candidates for multiorgan resection among patients with T4 gastric carcinoma.
OBJECTIVE
Indications for gastrectomy in T4 gastric carcinoma (GC) remain controversial. Our aim was to define prognostic factors to select those patients with best chance to benefit from multiorgan resection.


METHODS
A cohort of patients with T4 GC treated in a 19-year period. Surgical morbidity-associated factors were identified by logistic regression analysis. Prognostic factors were defined by Kaplan-Meier and Cox methods.


RESULTS
Seven hundred eighteen patients were included (gastrectomy performed in 169). Surgical morbidity and mortality were 39% and 10.7%, respectively. Surgical morbidity were associated to extent of gastrectomy, age, serum albumin, and lymphocyte count (P = 0.0001). Presence of metastasis (hazard ratio [HR], 1.68; 95% confidence interval [95% CI], 1.19-2.36), albumin <3 g/dl plus lymphocytes <1,000 cells/mm(3) (HR, 2.9; 95% CI, 1.8-4.6), presence of ascites (HR, 2.1; 95% CI, 1.06-4.2), age >or=50 (HR, 1.37; 95% CI, 1.02-1.8), and unresectable disease (HR, 2.6; 95% CI, 1.7-4.1) defined poor survival (P = 0.00001).


CONCLUSIONS
Performing a multiorgan resection must be balanced between chances for long-term survival and surviving a potentially fatal operation. Absence of metastases, serum albumin levels >3 g/dl, and accomplishment of R0 resection select patients with high probability of benefit from multiorgan resection.
Oñate-Ocaña
Luis F
LF
Clínica de Neoplasias Gástricas, Departamento de Gastroenterología, Instituto Nacional de Cancerología (INCan), Mexico City, Mexico. lfonate@gmail.com
Becker
Mauricio
M
Carrillo
José F
JF
Aiello-Crocifoglio
Vincenzo
V
Gallardo-Rincón
Dolores
D
Brom-Valladares
Rocío
R
Herrera-Goepfert
Roberto
R
Ochoa-Carrillo
Francisco
F
Beltrán-Ortega
Arturo
A
D000328:Adult; D000367:Age Factors; D000368:Aged; D000418:Albumins / Q000032:analysis; D013505:Digestive System Surgical Procedures / Q000401:mortality*; D005260:Female; D005743:Gastrectomy / Q000401:mortality; D006801:Humans; D018655:Lymphocyte Count; D008297:Male; D008875:Middle Aged; D009361:Neoplasm Invasiveness; D009362:Neoplasm Metastasis; D009367:Neoplasm Staging; D018579:Patient Selection; D011379:Prognosis; D013274:Stomach Neoplasms / Q000473:pathology / Q000601:surgery*; D016019:Survival Analysis; D013997:Time Factors
D000418:Albumins