A method to identify the best candidates for multiorgan resection among patients with T4 gastric carcinoma

Abstract

15141 Background: Background: Indications for gastrectomy in T4 gastric carcinoma (GC) remain controversial. Our aim was to develop a method for the selection of patients with T4 GC with best chances to receive a benefit from multiorgan resection. Methods: We analyzed a cohort of patients with T4 GC treated from January 1987 to December 2005. Relevant clinical, pathological and therapeutic variables were recorded. Prognostic factors associated with survival were defined by Kaplan-Meier and Cox’s methods. Factors associated to surgical morbidity were selected by Logistic Regression analysis. Results: 718 patients were included (gastrectomy performed in 169). Presence of metastasis (Hazard ratio=1.68 [HR], 95% confidence interval [CI] 1.19–2.36), albumin <3 g/dL plus lymphocytes <1,000 cells/mm3 (HR=2.9, 95% CI 1.8–4.6), presence of ascites (HR=2.1, 95% CI 1.06–4.2), 50 years old or more (HR=1.37, 95% CI 1.02–1.8) and surgical resection not possible (HR=2.6, 95% CI 1.7–4.1) define patients with the worst survival (model p=0.00001). Including only patients who underwent surgical resection, presence of metastases, extent of gastrectomy, serum albumin level and R1-R2 residual were determinants of poor survival (model p=0.00001). Surgical morbidity and mortality were 39% and 10.7%, respectively. The significant factor associated to surgical morbidity were extent of gastrectomy, age, serum albumin and lymphocyte count (model p=0.0001). Conclusion: The decision to perform a curative gastrectomy in patients with T4 GC must be balanced between the chances of long-term survival and the chances to survive a potentially fatal operation. Abscence of lymph node and distant metastases, adequate blood lymphocyte count and normal serum albumin levels could help to select those patients with high probability to receive benefit from multiorgan resection as long as R0 resection is performed. The role of preoperative chemoradiation or perioperative chemotherapy in T4 GC must be defined. No significant financial relationships to disclose.