TY - JOUR
T1 - Aggressive surgical approach for patients with T4 gastric carcinoma
T2 - Promise or myth?
AU - Cheng, Chi Tung
AU - Tsai, Chun Yi
AU - Hsu, Jun Te
AU - Vinayak, Rohan
AU - Liu, Keng Hao
AU - Yeh, Chun Nan
AU - Yeh, Ta Sen
AU - Hwang, Tsann Long
AU - Jan, Yi Yin
N1 - Funding Information:
ACKNOWLEDGMENT This work was partly supported by the Chang Gung Medical Research Program, Taiwan (CMRPG 380161), and the grants of Department of Health, Taiwan (DOH99-TD-C-111-006; PMRPG390071).
PY - 2011/6
Y1 - 2011/6
N2 - 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.
AB - 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.
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U2 - 10.1245/s10434-010-1534-x
DO - 10.1245/s10434-010-1534-x
M3 - Article
C2 - 21222167
AN - SCOPUS:79956201597
SN - 1068-9265
VL - 18
SP - 1606
EP - 1614
JO - Annals of surgical oncology
JF - Annals of surgical oncology
IS - 6
ER -
