Surgical Outcomes in Patients with T4 Gastric Carcinoma
Received 18 August 2005; received in revised form 16 October 2005; accepted 26 October 2005.
Background
There is controversy about the best therapeutic surgical approach for treatment of patients with T4 gastric cancer.
Study design
We used univariate and multivariate analyses to review the surgical outcomes and prognostic factors of 117 patients who underwent surgery for T4 gastric carcinoma.
Results
Curative resection was performed in 38 (32.4%) patients, with the pancreas being the most frequently resected organ. The 5-year survival rate was 16.0% and the median survival time (MST) was 11 months for all 117 registered patients. The 5-year survival rates and MSTs in patients after curative and noncurative resection were 32.2% versus 9.5% and 20 months versus 8 months, respectively. These values differed considerably between the two groups (p < 0.0001). Curability was an independent prognostic factor among all registered patients, including those who underwent noncurative resection. A relatively small tumor diameter (< 100 mm) and few lymph node metastases (six or fewer metastatic lymph nodes) were independent prognostic factors when curative resection could be performed. Postoperative morbidity and mortality were acceptable after curative combined resection.
Conclusions
We recommend the use of aggressive combined resection of adjacent organs, with extended lymph node dissection, for patients with T4 gastric carcinoma in whom curative resection can be used; that is, those with few metastatic lymph nodes (six or less) and a relatively small tumor diameter (100 mm). But noncurative resection should be avoided in patients with T4 gastric cancer.
⁎Department of Gastroenterological Surgery, Yokohama City University Graduate School of Medicine, Yokohama, Japan.
†Department of Surgery, Yokosuka Kyosai Hospital, Yokohama, Japan.
‡Department of Surgery, Yokohama Municipal Hospital, Yokohama, Japan.
Correspondence address: Chikara Kunisaki, MD, Department of Gastroenterological Surgery, Yokohama City University Graduate School of Medicine, 3–9 Fukuura, Kanazawa-ku, Yokohama, 236–0004, Japan.
ABSTRACT