Combined resection of the involved organs in T4 gastric cancer

It remains controversial whether extended surgeries for gastric cancer can improve the postoperative survival rate. This study was designed to evaluate the effectiveness of a combined resection of the involved organs for improving the survival of gastric cancer patients.

Of the 1600 patients treated at our Department, from 1969-1993, 231 patients were found to have evidence of adjacent organ spread at laparotomy. Of the 231 patients, 174 underwent a combined resection of the adjacent organs with a gastrectomy due to direct invasion of these organs by the gastric cancer. The clinicopathological characteristics of 231 patients who had adjacent organ spread were compared retrospectively with 495 patients who had no adjacent organ spread.

Although the postoperative survival rate of those patients who underwent a gastrectomy with a combined resection of the involved organs was poor, 14 patients survived for 5 years or longer after the surgery. The clinicopathologic factors characteristic of these 14 surviving patients were a lesser extent of lymph node metastasis and high operative curability.

A combined resection of the involved organs with a gastrectomy should be performed when lymph node metastasis is not evident.