Surgical outcomes and prognostic factors for T4 gastric cancers.
OBJECTIVE
In locally advanced gastric carcinomas that have invaded adjacent organs, the prognosis is poor. When combined resections are performed in T4 gastric cancers, a high morbidity rate is reported and it is inconclusive as to whether or not there is an improvement in the survival rate. We investigated surgical outcomes and analysed the prognostic factors for T4 gastric cancers.


METHODS
Between January 1992 and December 2000, 132 patients underwent surgery for T4 gastric cancer; they were divided into three groups: combined resections in group I, gastrectomy alone in group II, and resections not performed but palliative gastrojejunostomy or intraperitoneal chemotherapy in group III. Surgical outcomes and clinicopathologic factors were compared and prognostic factors were evaluated.


RESULTS
Among the three groups, statistically significantly different factors were tumour location, Borrmann type, tumour size, distant metastasis and peritoneal metastasis. The most commonly resected organ was the transverse colon, and 14 post-operative morbidities developed. In the multivariate analysis, the treatment group and curability were proved to be independent prognostic factors.


CONCLUSIONS
In patients with T4 gastric carcinoma, an aggressive surgical approach can be beneficial when curative resection is performed. If curative resection is not possible, palliative resection can be performed for a better quality of life.
Kim
Jong-Han
JH
Department of Surgery, Korea University College of Medicine, Ansan City, South Korea. ppongttai@medimail.co.kr
Jang
You-Jin
YJ
Park
Sung-Soo
SS
Park
Seong-Heum
SH
Kim
Seung-Joo
SJ
Mok
Young-Jae
YJ
Kim
Chong-Suk
CS
D003131:Combined Modality Therapy; D005260:Female; D005743:Gastrectomy; D006801:Humans; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D013274:Stomach Neoplasms / Q000401:mortality / Q000473:pathology / Q000601:surgery*