Retrospective Study
Copyright ©The Author(s) 2021. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Clin Cases. Oct 16, 2021; 9(29): 8718-8728
Published online Oct 16, 2021. doi: 10.12998/wjcc.v9.i29.8718
Retrospective analysis of surgically treated pT4b gastric cancer with pancreatic head invasion
Peng Jin, Hao Liu, Fu-Hai Ma, Shuai Ma, Yang Li, Jian-Ping Xiong, Wen-Zhe Kang, Hai-Tao Hu, Yan-Tao Tian
Peng Jin, Hao Liu, Fu-Hai Ma, Shuai Ma, Yang Li, Jian-Ping Xiong, Wen-Zhe Kang, Hai-Tao Hu, Yan-Tao Tian, Department of Pancreatic and Gastric Surgery, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100021, China
Author contributions: Jin P and Liu H were involved in study conception, data analysis and interpretation, production of tables and figures, writing the first draft, and revising it critically in light of comments from other authors and reviewers; Ma FH was involved in production of high-resolution figures and manuscript revision; Tian YT was involved in study conception and design, data interpretation, manuscript revision, and discussion; Li Y, Kang WZ and Ma S were involved in data acquisition and literature review; Hu HT and Xiong JP were involved in the manuscript revision and discussion.
Supported by National Natural Science Foundation of China, No. 81772642 and No. 82072734.
Institutional review board statement: The study was approved by the Institutional Review Board of National Clinical Research Center for Cancer/Cancer Hospital (No. 14-067/857).
Informed consent statement: The patient provided informed written consent.
Conflict-of-interest statement: The authors declare that they have no competing interests.
Data sharing statement: Technical appendix, statistical code, and dataset available from the corresponding author at [tianyantao@cicams.ac.cn].
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Yan-Tao Tian, MD, Professor, Department of Pancreatic and Gastric Surgery, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, No. 17 Panjiayuan Nanli, Chaoyang District, Beijing 100021, China. tianyantao@cicams.ac.cn
Received: June 2, 2021
Peer-review started: June 2, 2021
First decision: June 22, 2021
Revised: July 3, 2021
Accepted: August 5, 2021
Article in press: August 5, 2021
Published online: October 16, 2021
Abstract
BACKGROUND

For advanced gastric cancer patients with pancreatic head invasion, some studies have suggested that extended multiorgan resections (EMR) improves survival. However, other reports have shown high rates of morbidity and mortality after EMR. EMR for T4b gastric cancer remains controversial.

AIM

To evaluate the surgical approach for pT4b gastric cancer with pancreatic head invasion.

METHODS

A total of 144 consecutive patients with gastric cancer with pancreatic head invasion were surgically treated between 2006 and 2016 at the China National Cancer Center. Gastric cancer was confirmed in 76 patients by postoperative pathology and retrospectively analyzed. The patients were divided into the gastrectomy plus en bloc pancreaticoduodenectomy group (GP group) and gastrectomy alone group (GA group) by comparing the clinicopathological features, surgical outcomes, and prognostic factors of these patients.

RESULTS

There were 24 patients (16.8%) in the GP group who had significantly larger lesions (P < 0.001), a higher incidence of advanced N stage (P = 0.030), and less neoadjuvant chemotherapy (P < 0.001) than the GA group had. Postoperative morbidity (33.3% vs 15.3%, P = 0.128) and mortality (4.2% vs 4.8%, P = 1.000) were not significantly different in the GP and GA groups. The overall 3-year survival rate of the patients in the GP group was significantly longer than that in the GA group (47.6%, median 30.3 mo vs 20.4%, median 22.8 mo, P = 0.010). Multivariate analysis identified neoadjuvant chemotherapy [hazard ratio (HR) 0.290, 95% confidence interval (CI): 0.103–0.821, P = 0.020], linitis plastic (HR 2.614, 95% CI: 1.024–6.675, P = 0.033), surgical margin (HR 0.274, 95% CI: 0.102–0.738, P = 0.010), N stage (HR 3.489, 95% CI: 1.334–9.120, P = 0.011), and postoperative chemoradiotherapy (HR 0.369, 95% CI: 0.163–0.836, P = 0.017) as independent predictors of survival in patients with pT4b gastric cancer and pancreatic head invasion.

CONCLUSION

Curative resection of the invaded pancreas should be performed to improve survival in selected patients. Invasion of the pancreatic head is not a contraindication for surgery.

Keywords: Gastric cancer, T4, R0 resection, Prognostic factors, Extended multiorgan resection, Pancreatectomy

Core tip: This was a retrospective study to evaluate the surgical approach for pT4b gastric cancer with pancreatic head invasion. The overall 3-year survival rate of the patients in the gastrectomy plus en bloc pancreaticoduodenectomy group was significantly longer than that in the gastrectomy alone group. Curative resection of the invaded pancreas should be performed to improve survival after balancing the risk and survival benefit.