title: Appropriate selection of patients for combined organ resection in cases of gastric carcinoma invading adjacent organs.
abstract: OBJECTIVE
  Proper patient selection for multi-organ resection in T4 gastric carcinoma remains controversial. Our aim was to investigate which patients might benefit from multi-organ resection.
  
  
  METHODS
  Among 1,775 consecutive patients receiving gastric cancer surgery, 71 had adjacent organ invasion. Short- and long-term surgical outcomes and associations between clinicopathological factors and overall survival were investigated.
  
  
  RESULTS
  Forty-seven patients underwent curative surgery with multi-organ resection, and 24 underwent non-curative surgery, with or without multi-organ resection. Postoperative morbidity and mortality rates were 31.7% and 3.3%, respectively. Patients receiving curative surgery via multi-organ resection survived longer than those without (MST, 31.5 months vs. 19.1 months, P = 0.046). Multi-organ resection did not affect survival when performed in non-curative surgery. N3 lymph node metastasis was an independent prognostic factor for poor outcome (HR = 3.89, 95% CI = 1.40-10.83) in curatively resected patients; patients with N3 lymph node metastasis showed similar survival to patients receiving non-curative surgery.
  
  
  CONCLUSIONS
  Multi-organ resection should be performed only when no incurable factors are present, and R0 resection is most likely. Multi-organ organ resection does not, however, seem to be effective in patients with N3 lymph node metastasis, even when curative resection is performed.
authors.affiliation: Division of Gastroenterologic Surgery, Department of Surgery, Chonnam National University Hwasun Hospital, Chonnam National University College of Medicine, Jeollanam-do, Korea.
authors.forename: Oh
authors.initials: O
authors.lastname: Jeong
authors.forename: Won Yong
authors.initials: WY
authors.lastname: Choi
authors.forename: Young Kyu
authors.initials: YK
authors.lastname: Park
mesh_terms: D000328:Adult; D000368:Aged; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009361:Neoplasm Invasiveness; D009364:Neoplasm Recurrence, Local; D018579:Patient Selection; D011183:Postoperative Complications / Q000209:etiology; D011379:Prognosis; D012307:Risk Factors; D013274:Stomach Neoplasms / Q000401:mortality / Q000473:pathology / Q000601:surgery*