Abstract
The aim of this retrospective study was to analyze the morbidity, mortality, and survival rates of extended multiorgan resection (EMR) for locally advanced gastric cancer patients compared to gastrectomy alone and a palliative operation. 893 locally advanced gastric cancer patients without distant metastasis had surgery including gastrectomy alone (GA group, n = 798), EMR resection (EMR group, n = 75), and palliative operation (palliative gastrectomy or gastrojejunostomy (PO group, n = 20)). Postoperative mortality and complication rates in the EMR group were significantly higher than in the GA group (2.7% vs 0.4%, P = 0.010 and 25.3% vs 8.1%, P < 0.001, respectively), but similar in the PO group. The median survival time of the EMR group was significantly longer than in the PO group (27 months vs 11 months, P = 0.020), but significantly worse (P = 0.020) than in the GA group (44 months). Incompleteness of resection (R1) and linitis plastica were independent prognostic factors for survival in the EMR group. Three different gastric cancer surgeries led to different postoperative mortality and complication rates. EMR had a better survival rate compared with PO while GA had the longest survival time with the lowest mortality and complication rates.
Highlights
Gastric cancer is one of the most common forms of cancer detected worldwide and is a leading cause of death
Patients were allocated into 3 groups according to the surgical approaches used: radical gastrectomy alone (GA group, n = 798), extended multiorgan resection (EMR group, n = 75) and a palliative operation group including palliative gastrectomy and gastrojejunostomy (PO group, n = 20)
Bleeding and pyloric obstruction were commonly associated with these patients
Summary
Gastric cancer is one of the most common forms of cancer detected worldwide and is a leading cause of death. Gastric cancer typically presents at a locally advanced stage, even invading into adjacent organs in many of our patients in China. For these patients, extended multiorgan resection (EMR) is advocated as the operation of choice for achieving R0 resections, which has been identified as an important indicator of longer term survival in patients undergoing curative surgery for gastric cancer[2,3,4] and the long-term outcomes of palliative resection or non-surgical treatments such as chemotherapy for locally advanced gastric cancer are dismal[5]. We retrospectively assessed the effectiveness of EMR compared with gastrectomy alone or palliative surgery in patients with local gastric cancer
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