Jin P, Liu H, Ma FH, Ma S, Li Y, Xiong JP, Kang WZ, Hu HT, Tian YT. Retrospective analysis of surgically treated pT4b gastric cancer with pancreatic head invasion . World J Clin Cases 2021; 9(29): 8718-8728 [PMID: 34734050 DOI: 10.12998/wjcc.v9.i29.8718]
Corresponding Author of This Article
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
Research Domain of This Article
Oncology
Article-Type of This Article
Retrospective Study
Open-Access Policy of This Article
This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (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/
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 byNational 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 Processing time: 134 Days and 21.8 Hours
ARTICLE HIGHLIGHTS
Research background
For advanced gastric cancer patients with pancreatic head invasion, extended multiorgan resection remains controversial.
Research motivation
This study investigated the clinicopathological features, surgical outcomes, and prognostic factors of these patients.
Research objectives
This study aimed to evaluate the surgical approach for pT4b gastric cancer with pancreatic head invasion.
Research methods
A total of 143 consecutive gastric cancer with pancreatic head invasion were surgically treated between 2006 and 2016 at the China National Cancer Center. Of these patients, 76 confirmed by postoperative pathology were retrospectively analyzed. They were divided into the gastrectomy plus en bloc pancreaticoduodenectomy group (GP group) and gastrectomy alone group (GA group). The clinicopathological features, surgical outcomes, and prognostic factors of these patients were compared.
Research results
The GP group had significantly larger lesions (P < 0.001), higher incidence of advanced N stage cancer (P = 0.030), and less neoadjuvant chemotherapy (NAC) (P < 0.001) than the GA group. 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 NAC [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.
Research conclusions
NAC followed by curative resection including radical gastrectomy, extensive lymph node dissection, and en bloc resection of invaded pancreas plus postoperative chemoradiotherapy might be considered as a valid treatment option to improve the survival rate of patients with pT4b gastric cancer with pancreatic head invasion.
