Surgical impact on gastric cancer with locoregional invasion

The benefit of resection of gastric cancer with locoregional invasion is still under debate. This study aimed to investigate the impact of surgery on patients with gastric cancer with locoregional invasion.

From January 1988 to December 2009, a total of 2,678 patients with gastric cancer underwent surgery at the Department of Surgery, Taipei Veterans General Hospital. Among these patients, 569 and 295 were diagnosed as T4a (serosa invasion without penetration of visceral peritoneum) and T4b (serosa exposure with invasion of adjacent structure), respectively. Invasion type and prognosis were analyzed in patients with gastric cancer who had either curative or palliative resection.

Our results showed that patients with T4a gastric cancer had a better 5-year overall survival than patients with T4b (22.5% vs. 11.5%, P < 0.001). Patients with T4b who had curative resection had a better 5-year overall survival than those with T4b who had palliative resection (13.8% vs. 7.3%, P = 0.001). The prognosis of patients with gastric cancer with pancreas invasion was worse than those with mesocolon invasion, as no patients with pancreas invasion survived more than 5 years. Univariate and multivariate analyses showed that tumor size (P = 0.019), Bormann classification (P < 0.001), stromal reaction (P = 0.001), and nodal involvement (P < 0.001) were independent predictors for overall survival in patients with T4b gastric cancer.

Resection of T4b gastric cancer could be performed with curative intent. Patients with gastric cancer with pancreas invasion had a poorer prognosis than those with mesocolon invasion.