Volume 32, Issue 4, Pages 198-204 (October 2009)

2 of 11

ABSTRACT

ABSTRACT + REFS

FULL-TEXT PDF (188 KB)

Surgical Outcomes and Prognostic Factors for T4 Gastric Cancers

Accepted 29 August 2009.

Purpose

In locally advanced gastric carcinomas that have invaded adjacent organs, the prognosis is poor. When combined resections are performed in T4 gastric cancers, a high morbidity rate is reported and it is inconclusive as to whether or not there is an improvement in the survival rate. We investigated surgical outcomes and analysed the prognostic factors for T4 gastric cancers.

Patients and Methods

Between January 1992 and December 2000, 132 patients underwent surgery for T4 gastric cancer; they were divided into three groups: combined resections in group I, gastrectomy alone in group II, and resections not performed but palliative gastrojejunostomy or intraperitoneal chemotherapy in group III. Surgical outcomes and clinicopathologic factors were compared and prognostic factors were evaluated.

Results

Among the three groups, statistically significantly different factors were tumour location, Borrmann type, tumour size, distant metastasis and peritoneal metastasis. The most commonly resected organ was the transverse colon, and 14 post-operative morbidities developed. In the multivariate analysis, the treatment group and curability were proved to be independent prognostic factors.

Conclusion

In patients with T4 gastric carcinoma, an aggressive surgical approach can be beneficial when curative resection is performed. If curative resection is not possible, palliative resection can be performed for a better quality of life.

Key Words: prognostic factors , surgical resection , T4 gastric cancer

No full text is available. To read the body of this article, please view the PDF online.

Article Outline

• Abstract

• References

• Copyright

References

1. 1 Roder DM . The epidemiology of gastric cancer . Gastric Cancer . 2002;5(Suppl 1):5–11 . CrossRef

2. 2 Neugut AI , Hayek M , Howe G . Epidemiology of gastric cancer . Semin Oncol . 1996;23:281–291 . MEDLINE

3. 3 Siewert JR , Bottcher K , Stein HJ , et al. Relevant prognostic factors in gastric cancer: ten-year results of the German Gastric Cancer Study . Ann Surg . 1998;228:449–461 . MEDLINE | CrossRef

4. 4 Wu CW , Hsieh MC , Lo SS , et al. Prognostic indicators for survival after curative resection for patients with carcinoma of the stomach . Dig Dis Sci . 1997;42:1265–1269 . MEDLINE | CrossRef

5. 5 Shchepotin IB , Chorny VA , Nauta RJ , et al. Extended surgical resection in T4 gastric cancer . Am J Surg . 1998;175:123–126 . Abstract | Full-Text PDF (478 KB) | CrossRef

6. 6 Isozaki H , Tanaka N , Tanigawa N , et al. Prognostic factors in patients with advanced gastric cancer with macroscopic invasion to adjacent organs treated with radical surgery . Gastric Cancer . 2000;3:202–210 . CrossRef

7. 7 Kim DY , Joo JK , Seo KW , et al. T4 gastric carcinoma: the benefit of non-curative resection . ANZ J Surg . 2006;76:453–457 . MEDLINE | CrossRef

8. 8 Kitamura K , Tani N , Koike H , et al. Combined resection of the involved organs in T4 gastric cancer . Hepatogastroenterology . 2000;470:1769–1772 .

9. 9 Kunisaki C , Akiyama H , Nomura M , et al. Surgical outcomes in patients with T4 gastric carcinoma . J Am Coll Surg . 2006;202:223–230 . Abstract | Full Text | Full-Text PDF (211 KB) | CrossRef

10. 10 Martin RC , Jaques DP , Brennan MF , et al. Extended local resection for advanced gastric cancer: increased survival versus increased morbidity . Ann Surg . 2002;236:159–165 . MEDLINE | CrossRef

11. 11 Kobayashi A , Nakagohri T , Konishi M , et al. Aggressive surgical treatment for T4 gastric cancer . J Gastrointest Surg . 2004;8:464–470 . CrossRef

12. 12 Hartgrink HH , Putter H , Klein Kranenbarg E , et al. Value of palliative resection in gastric cancer . Br J Surg . 2002;89:1438–1443 . MEDLINE | CrossRef

13. 13 Moriwaki Y , Kunisaki C , Kobayashi S , et al. Does the surgical stress associated with palliative resection for patients with incurable gastric cancer with distant metastasis shorten their survival? . Hepatogastroenterology . 2004;51:872–875 . MEDLINE

14. 14 Saidi RF , ReMine SG , Dudrick PS , et al. Is there a role for palliative gastrectomy in patients with stage IV gastric cancer? . World J Surg . 2006;30:21–27 . MEDLINE | CrossRef

15. 15 Lim S , Muhs BE , Marcus SG , et al. Results following resection for stage IV gastric cancer; are better outcomes observed in selected patient subgroups? . J Surg Oncol . 2007;95:118–122 . MEDLINE | CrossRef

16. 16 Saito H , Fukumoto Y , Osaki T , et al. Distinct recurrence pattern and outcome of adenocarcinoma of the gastric cardia in comparison with carcinoma of other regions of the stomach . World J Surg . 2006;30:1864–1869 . MEDLINE | CrossRef

17. 17 Jacob CE , Gama-Rodrigues J , Bresciani CJ , et al. Trends in tumor location in gastric carcinoma over a 28-year period . Hepatogastroenterology . 2007;54:1297–1301 .

18. 18 Chen CY , Wu CW , Lo SS , et al. Peritoneal carcinomatosis and lymph node metastasis are prognostic indicators in patients with Borrmann type IV gastric carcinoma . Hepatogastroenterology . 2002;49:874–877 . MEDLINE

19. 19 Sugarbaker PH , Yu W , Yonemura Y . Gastrectomy, peritonectomy, and perioperative intraperitoneal chemotherapy: the evolution of treatment strategies for advanced gastric cancer . Semin Surg Oncol . 2003;21:233–248 . MEDLINE | CrossRef

20. 20 Yonemura Y , Bandou E , Kinoshita K , et al. Effective therapy for peritoneal dissemination in gastric cancer . Surg Oncol Clin N Am . 2003;12:635–648 . Full Text | Full-Text PDF (525 KB) | CrossRef

21. 21 Kobayashi O , Tsuburaya A , Yoshikawa T , et al. The efficacy of gastrectomy for large gastric cancer . Int J Clin Oncol . 2006;11:44–50 . MEDLINE | CrossRef

22. 22 Shiraishi N , Sato K , Yasuda K , et al. Multivariate prognostic study on large gastric cancer . J Surg Oncol . 2007;96:14–18 . CrossRef

23. 23 Colen KL , Marcus SG , Newman E , et al. Multiorgan resection for gastric cancer: intraoperative and computed tomography assessment of locally advanced disease is inaccurate . J Gastrointest Surg . 2004;8:899–902 .

24. 24 Dhar DK , Kubota H , Tachibana M , et al. Prognosis of T4 gastric carcinoma patients: an appraisal of aggressive surgical treatment . J Surg Oncol . 2001;76:278–282 . MEDLINE | CrossRef

25. 25 Carboni F , Lepiane P , Santoro R , et al. Extended multiorgan resection for T4 gastric carcinoma: 25-year experience . J Surg Oncol . 2005;90:95–100 . MEDLINE | CrossRef

26. 26 Otsuji E , Yamaguchi T , Sawai K , et al. Total gastrectomy with simultaneous pancreaticosplenectomy or splenectomy in patients with advanced gastric carcinoma . Br J Cancer . 1999;79:1789–1793 . MEDLINE | CrossRef

27. 27 Kasakura Y , Fujii M , Mochizuki F , et al. Is there a benefit of pancreaticosplenectomy with gastrectomy for advanced gastric cancer? . Am J Surg . 2000;179:237–242 . Abstract | Full Text | Full-Text PDF (282 KB) | CrossRef

Department of Surgery, Korea University College of Medicine, Ansan City, South Korea

Address correspondence and reprint requests to Assistant Professor Jong-Han Kim, Department of Surgery, Korea University College of Medicine, Korea University Ansan Hospital, 516, Gojan-Dong, Ansan City, Gyeong gi-Do 425-707, Korea

PII: S1015-9584(09)60395-X

doi:10.1016/S1015-9584(09)60395-X

2 of 11