title: Multivisceral resection for gastric cancer: a systematic review.
abstract: BACKGROUND
  The overall prognosis and survival of patients with advanced gastric cancer is generally poor. One of the most powerful predictors of outcomes in gastric cancer surgery is an R0 resection. However, the extent of the required surgical resection and the additional benefit of multivisceral resection (MVR) are controversial.
  
  
  METHODS
  Electronic literature searches were conducted using Medline, EMBASE, and the Cochrane Central Register of Controlled Trials from January 1, 1998 to December 31, 2009. All search titles and abstracts were independently rated for relevance by a minimum of two reviewers.
  
  
  RESULTS
  Seventeen studies were included in this review. Among the 1343 patients who underwent MVR, overall complication rates ranged from 11.8 to 90.5%. Perioperative mortality was found to be 0-15%. Pathological T4 disease was confirmed in 28.8-89% of patients. R0 resection and extent of nodal involvement were important predictors of survival in patients undergoing MVR. Patient outcomes may also be affected by the number of organs resected.
  
  
  CONCLUSIONS
  Gastrectomy with MVR can be safely pursued in patients with locally advanced gastric cancer to achieve an R0 resection. MVR may not be beneficial in patients with extensive nodal disease.
authors.affiliation: Division of Surgical Oncology, Odette Cancer Centre, Sunnybrook Health Sciences Centre, University of Toronto, Suite T2-60, 2075 Bayview Ave, Toronto, ON, M4N 3M5, Canada.
authors.forename: Savtaj S
authors.initials: SS
authors.lastname: Brar
authors.forename: Rajini
authors.initials: R
authors.lastname: Seevaratnam
authors.forename: Roberta
authors.initials: R
authors.lastname: Cardoso
authors.forename: Lavanya
authors.initials: L
authors.lastname: Yohanathan
authors.forename: Calvin
authors.initials: C
authors.lastname: Law
authors.forename: Lucy
authors.initials: L
authors.lastname: Helyer
authors.forename: Natalie G
authors.initials: NG
authors.lastname: Coburn
mesh_terms: D005743:Gastrectomy / Q000009:adverse effects / Q000379:methods* / Q000401:mortality; D006801:Humans; D008207:Lymphatic Metastasis; D017063:Outcome Assessment, Health Care; D011379:Prognosis; D013274:Stomach Neoplasms / Q000473:pathology / Q000601:surgery*; D016019:Survival Analysis