Aggressive surgical approach for patients with T4 gastric carcinoma: Promise or myth?

Chi Tung Cheng*, Chun Yi Tsai, Jun Te Hsu, Rohan Vinayak, Keng Hao Liu, Chun Nan Yeh, Ta Sen Yeh, Tsann Long Hwang, Yi Yin Jan

*Corresponding author for this work

Research output: Contribution to journalJournal Article peer-review

53 Scopus citations

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.

Original languageEnglish
Pages (from-to)1606-1614
Number of pages9
JournalAnnals of Surgical Oncology
Volume18
Issue number6
DOIs
StatePublished - 06 2011

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