Abstract
Simple SummaryGastric adenocarcinoma (GC) is the fifth most common malignancy and third leading cause of cancer-related mortality worldwide. Multiorgan resection is necessary to achieve clear R0 margins in GC patients with adjacent organ invasion (T4b). However, whether these patients benefit from aggressive surgery involving pancreatic resection (PR) remains unclear. Here we aimed to evaluate the impact of PR on survival in patients with locally advanced resectable GC. We found that the patients with T4b lesions who underwent PR had poorer survival than those who underwent resection of other adjacent organs. Further pancreaticoduodenectomy did not improve survival in pT3–pT4 GC patients with positive duodenal margins. These findings may be useful to practicing clinicians by aiding optimal decision making for treatment plans and surgical procedures.Whether gastric adenocarcinoma (GC) patients with adjacent organ invasion (T4b) benefit from aggressive surgery involving pancreatic resection (PR) remains unclear. This study aimed to clarify the impact of PR on survival in patients with locally advanced resectable GC. Between 1995 and 2017, patients with locally advanced GC undergoing radical-intent gastrectomy with and without PR were enrolled and stratified into four groups: group 1 (G1), pT4b without pancreatic resection (PR); group 2 (G2), pT4b with PR; group 3 (G3), positive duodenal margins without Whipple’s operation; and group 4 (G4), cT4b with Whipple’s operation. Demographics, clinicopathological features, and outcomes were compared between G1 and G2 and G3 and G4. G2 patients were more likely to have perineural invasion than G1 patients (80.6% vs. 50%, p < 0.001). G4 patients had higher lymph node yield (40.8 vs. 31.3, p = 0.002), lower nodal status (p = 0.029), lower lymph node ratios (0.20 vs. 0.48, p < 0.0001) and higher complication rates (45.2% vs. 26.3%, p = 0.047) than G3 patients. The 5-year disease-free survival (DFS) and overall survival (OS) rates were significantly longer in G1 than in G2 (28.1% vs. 9.3%, p = 0.003; 32% vs. 13%, p = 0.004, respectively). The 5-year survival rates did not differ between G4 and G3 (DFS: 14% vs. 14.4%, p = 0.384; OS: 12.6% vs. 16.4%, p = 0.321, respectively). In conclusion, patients with T4b lesion who underwent PR had poorer survival than those who underwent resection of other adjacent organs. Further Whipple’s operation did not improve survival in pT3–pT4 GC with positive duodenal margins.
Highlights
Gastric adenocarcinoma (GC) is the fifth most common malignancy, with approximately 950,000 newly diagnosed cases annually and is the third leading cause of cancerrelated mortality globally (700,000 deaths per year) [1,2]
Patients were stratified into four groups according to the pancreatic resection (PR) or distal duodenal margins status: group 1 (G1), pT4b without PR; group 2 (G2), pT4b with PR; group 3 (G3), positive duodenal margins without Whipple’s operation; group 4 (G4), cT4b with Whipple’s operation
There was no difference in the variables including age, sex, tumor size, tumor location, type of gastrectomy, nodal status, staging, the number of retrieved lymph nodes, lymph node ratio (LNR), differentiation, and the presence of lymphatic or vascular invasion between two groups
Summary
Gastric adenocarcinoma (GC) is the fifth most common malignancy, with approximately 950,000 newly diagnosed cases annually and is the third leading cause of cancerrelated mortality globally (700,000 deaths per year) [1,2]. The more of the involved organ are resected, the higher are the rates of surgery-related mortality and morbidity [5,9,10], which may defer patients from receiving further systemic therapy. This situation is especially remarkable in patients undergoing gastrectomy plus pancreatic surgery since pancreatic resection (PR) is associated with considerably high rates of postoperative pancreatic fistula and intra-abdominal infection [6,7,8]. Patient nutrition status or general performance usually deteriorated significantly after Whipple’s operation
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