title: Extended multi-organ resection for cT4 gastric carcinoma: A retrospective analysis.
abstract: OBJECTIVE
  Combined resection for locally advanced (T4) gastric cancer may result in high morbidity and mortality. The aim of this study was to evaluate the clinicopathologic characteristics to determine the prognostic factors for T4 gastric cancers.
  
  
  METHODS
  A total of 463 consecutive patients with gastric cancers were enrolled in this study. Among them, 63 patients received combined resections. Various clinicopathologic factors influencing survival rates were evaluated. Survival rates were calculated according to the Kaplan-Meier method. Prognostic factors were evaluated by the univariate and multivariate analysis.
  
  
  RESULTS
  Thirty-one patients (49.2%) received one additional organ resection and 32 patients (50.8%) received two or more additional organ resections. Curative resection was performed in 49 patients (77.8%). Multivariate analysis identified curative resection (hazard ratio 0.330; 95 percent confidence interval, 0.139-0.784; P = 0.012) and tumor diameter (> 7 cm) (hazard ratio, 3.589; the 95 percent confidence interval, 1.425-9.037; P = 0.007) as independent prognostic factor for patients with T4 gastric cancer undergoing combined resection.
  
  
  CONCLUSIONS
  The use of aggressive multi-organ resection was recommended for patients with T4 gastric carcinoma, with tumor diameter as a useful indicator. Patients with relatively small tumor diameter (≤ 7cm) could benefit from multi-organ resections.
authors.affiliation: Longbin Xiao, Department of Gastrointestinal and Pancreatic Surgery, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China, 510700.
authors.forename: Longbin
authors.initials: L
authors.lastname: Xiao
authors.affiliation: Mingzhe Li, Department of Gastrointestinal and Pancreatic Surgery, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China, 510700.
authors.forename: Mingzhe
authors.initials: M
authors.lastname: Li
authors.affiliation: Fengfeng Xu, Department of General Surgery I, Huangpu Division of the First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China, 510700.
authors.forename: Fengfeng
authors.initials: F
authors.lastname: Xu
authors.affiliation: Huishao Ye, Department of Pharmacy, Huangpu Division of the First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China, 510700.
authors.forename: Huishao
authors.initials: H
authors.lastname: Ye
authors.affiliation: Wenhui Wu, Department of Gastrointestinal and Pancreatic Surgery, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China, 510700.
authors.forename: Wenhui
authors.initials: W
authors.lastname: Wu
authors.affiliation: Shuo Long, Department of Gastrointestinal and Pancreatic Surgery, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China, 510700.
authors.forename: Shuo
authors.initials: S
authors.lastname: Long
authors.affiliation: Wenfeng Li, Department of Gastrointestinal and Pancreatic Surgery, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China, 510700.
authors.forename: Wenfeng
authors.initials: W
authors.lastname: Li
authors.affiliation: Yulong He, Department of Gastrointestinal and Pancreatic Surgery, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China, 510700.
authors.forename: Yulong
authors.initials: Y
authors.lastname: He
keywords: Gastric cancer; Multiorgan resection; Prognostic factors