Extended surgical resection in T4 gastric cancer

Shchepotin, Igor B.; Chorny, Vyacheslav A.; Nauta, Russell J.; Shabahang, Mohsen; Buras, Robert R.; Evans, Stephen R.T.

doi:10.1016/S0002-9610(97)00268-7

« Previous Next »The American Journal of Surgery
Volume 175, Issue 2 , Pages 123-126, February 1998

Extended surgical resection in T₄ gastric cancer

Igor B. Shchepotin
- From the Department of Surgery, Georgetown University Medical Center, Washington, DC, USA
- From the Department of Ukrainian Institute of Oncology and Radiology, Kiev, Ukraine
- Requests for reprints should be addressed to Igor B. Shchepotin, MD, PhD, DSci, 3970 Reservoir Rd., NW, The Research Building W301, Georgetown University Medical Center, Washington, DC, 20007.
Vyacheslav A. Chorny
- From the Department of Ukrainian Institute of Oncology and Radiology, Kiev, Ukraine
Russell J. Nauta
- From the Department of Surgery, Georgetown University Medical Center, Washington, DC, USA
Mohsen Shabahang
- From the Department of Surgery, Georgetown University Medical Center, Washington, DC, USA
Robert R. Buras
- From the Department of Surgery, Georgetown University Medical Center, Washington, DC, USA
Stephen R.T. Evans
- From the Department of Surgery, Georgetown University Medical Center, Washington, DC, USA

Received 24 March 1997; accepted 3 September 1997.

Abstract

background

Some physicians still consider invasion of adjacent organs by the carcinoma of stomach as a sign of incurable disease.

methods

This retrospective study has been done with particular reference to 353 T₄ gastric cancer patients who underwent combined gastrectomies with adjacent organs.

results

Subtotal gastrectomy was performed in 237 (67.1%) patients and total gastrectomy was performed in 116 (32.9%) patients. Organs most commonly resected with the stomach were the transverse colon in 159 (45%) cases, the tail of pancreas and spleen in 150 (42.5%), the left lobe of liver in 101 (28.5%), and the head of pancreas in 37 (10.5%) patients. A total of 110 postoperative complications occurred in this subset of patients corresponding to a complication rate of 31.2%. A total of 48 postoperative deaths occurred in this subset of patients corresponding to a mortality rate of 13.6%. The 5-year survival rate for all patients who underwent combined gastrectomy with adjacent organs was 25%. Of the node-negative T₄ gastric cancer resections, 37% survived 5 years whereas the T₄ node-positive resections have only a 15% 5-year survival.

conclusions

Patients who present with T₄ gastric cancer (about 20% of the patient population) will benefit from aggressive en bloc surgical resection and should not be considered unresectable.

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