title: Aggressive surgical approach for patients with T4 gastric carcinoma: promise or myth?
abstract: BACKGROUND
  Surgical outcomes of multiorgan resection (MOR) for T4 gastric carcinoma reported in the literature are widely variable. We herein report a large surgical series of T4 gastric carcinoma.
  
  
  METHODS
  One hundred seventy-nine patients with cT4 gastric carcinoma were recruited onto the study. Patient characteristics, surgical strategy and related complications, long-term survival, and prognostic factors of T4 gastric carcinoma were analyzed.
  
  
  RESULTS
  Of 179 cT4 gastric carcinoma, there were 57 cT4 (pT3) with MOR, 91 pT4 with MOR, and 31 cT4 without MOR. pT4 with MOR were more likely to be associated with nodal metastasis, cellular dedifferentiation, and lymphoperineural infiltration compared to those of pT0-3 (P < 0.01 for all). For 91 pT4 with MOR, their surgical mortality and morbidity rates were 4.4 and 28.6%, respectively; their 1-, 3-, and 5-year overall survival rates were 55.2, 22.4, and 12.2%, respectively. The long-term survival of cT4 (pT3) with MOR was superior to pT4 with MOR (P = 0.006) and cT4 without MOR (P = 0.004). There was a striking difference between pT4 with MOR, R0 and pT4 with MOR, and R1 or R2 (P = 0.007). By means of multivariate analysis, lymph node status, liver invasion, and positive surgical margin were independent prognostic factors.
  
  
  CONCLUSIONS
  Aggressive surgical management of pT4 gastric carcinoma should be limited to patients without adverse prognostic factors such as advanced nodal involvement and pancreatic invasion.
authors.affiliation: Department of Surgery, Chang Gung Memorial Hospital at Linkou, Chang Gung University, Taipei, Taiwan.
authors.forename: Chi-Tung
authors.initials: CT
authors.lastname: Cheng
authors.forename: Chun-Yi
authors.initials: CY
authors.lastname: Tsai
authors.forename: Jun-Te
authors.initials: JT
authors.lastname: Hsu
authors.forename: Rohan
authors.initials: R
authors.lastname: Vinayak
authors.forename: Keng-Hao
authors.initials: KH
authors.lastname: Liu
authors.forename: Chun-Nan
authors.initials: CN
authors.lastname: Yeh
authors.forename: Ta-Sen
authors.initials: TS
authors.lastname: Yeh
authors.forename: Tsann-Long
authors.initials: TL
authors.lastname: Hwang
authors.forename: Yi-Yin
authors.initials: YY
authors.lastname: Jan
mesh_terms: D000368:Aged; D005260:Female; D005743:Gastrectomy; D006801:Humans; D008207:Lymphatic Metastasis; D008297:Male; D008875:Middle Aged; D009361:Neoplasm Invasiveness; D009367:Neoplasm Staging; D011183:Postoperative Complications; D013274:Stomach Neoplasms / Q000473:pathology* / Q000601:surgery*; D015996:Survival Rate; D016896:Treatment Outcome