Department of Digestive Surgery, Catholic University of Rome, Rome.
JAMA Surg. 2013 Apr;148(4):353-60. doi: 10.1001/2013.jamasurg.309.
The role of multivisceral resection, in the setting of locally advanced gastric cancer, is still debated. Previous studies have reported a higher risk for perioperative morbidity and mortality, with limited objective benefit in terms of survival. Conversely, recent studies have shown the feasibility of enlarged resections and the potential advantage of extended resection for clinical stage T4b gastric adenocarcinoma with good long-term results.
To analyze the role of multivisceral resection for locally advanced gastric cancer with particular attention to the brief and long-term results and to the prognostic value of clinical and pathologic factors.
Prospective multicenter study using data from between January 1, 1995, and December 31, 2008.
Seven Italian surgery centers.
A total of 2208 patients underwent curative resections for gastric carcinoma at the centers. Among them, 206 patients presented with a clinical T4b carcinoma. One hundred twelve underwent a combined resection of the adjacent organs with a gastrectomy owing to suspicion or direct invasion of these organs by the gastric cancer.
Clinical and pathologic variables were prospectively collected and the feasibility and efficacy of multivisceral resection for locally advanced clinical T4b gastric cancer were assessed.
Postoperative mortality and complication rates of patients who underwent a gastrectomy with a combined resection of the involved organs were 3.6% and 33.9%, respectively. Pathologic factors revealed that the nodal involvement was present in about 89.3% of patients and the mean (SD) number of pathologic lymph nodes was 14.8 (16.6). The overall 5-year survival rate was 27.2%. The completeness of resection and lymph node invasion represent independent prognostic parameters at multivariate analysis.
Our study indicates that patients undergoing extended resections experience acceptable postoperative morbidity and mortality rates, and an en bloc multivisceral resection should be performed in patients when a complete resection can be realistically obtained and when lymph node metastasis is not evident.
多脏器切除术在局部进展期胃癌中的作用仍存在争议。先前的研究报告显示，其围手术期发病率和死亡率较高，生存方面的客观获益有限。然而，最近的研究表明，对于临床 T4b 期胃腺癌，扩大切除是可行的，并且对于临床 T4b 期胃腺癌，扩大切除可能具有延长生存的优势，且长期效果良好。
分析多脏器切除术治疗局部进展期胃癌的作用，特别关注近期和远期结果，并分析临床和病理因素的预后价值。
前瞻性多中心研究，使用 1995 年 1 月 1 日至 2008 年 12 月 31 日的数据。
7 家意大利外科中心。
在这些中心接受根治性胃切除术的患者共计 2208 例。其中，206 例为临床 T4b 癌患者。由于怀疑或直接侵犯胃癌，112 例患者接受了联合脏器切除术和胃切除术。
前瞻性收集临床和病理变量，评估多脏器切除术治疗局部进展期临床 T4b 胃癌的可行性和疗效。
行联合脏器切除术的患者胃切除术后死亡率和并发症发生率分别为 3.6%和 33.9%。病理因素显示，约 89.3%的患者存在淋巴结受累，平均（SD）病理淋巴结数为 14.8（16.6）枚。总 5 年生存率为 27.2%。在多变量分析中，切除的完整性和淋巴结侵犯是独立的预后因素。
本研究表明，接受扩大切除术的患者术后发病率和死亡率可接受，当能够实现完全切除且无明显淋巴结转移时，应行整块多脏器切除术。
