Published online Oct 16, 2021. doi: 10.12998/wjcc.v9.i29.8718
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
For advanced gastric cancer patients with pancreatic head invasion, extended multiorgan resection remains controversial.
This study investigated the clinicopathological features, surgical outcomes, and prognostic factors of these patients.
This study aimed to evaluate the surgical approach for pT4b gastric cancer with pancreatic head invasion.
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.
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.
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.
Surgical role for T4b patients.