[Multivisceral surgeries with pancreatoduodenectomy for gastric cancer: immediate and long-term results]

To study the immediate and long-term results of multivisceral surgeries with pancreaticoduodenectomy for gastric cancer.

The 1^st group included 24 patients who underwent multivisceral surgeries with pancreaticoduodenectomy for gastric cancer with pancreatic head and/or duodenum invasion. The 2^nd group included 60 patients with gastric cancer who underwent partial resection of the pancreatic head and/or duodenum rather pancreaticoduodenectomy.

ASA class III was observed in 10 (41.7%) out of 24 patients in the 1^st group and in 12 (20.0%) out of 60 patients in the 2^nd group (p=0.041). In group 2, there were no cases of vein invasion (0 versus 12.5%; p=0.021). In group 1, Clavien-Dindo grade ≥3 complications were more common (10 (41.7%) vs. 14 (23.3%) cases, p=0.005). Moreover, pancreatic fistulas of all classes were more common (9 (37.5%) vs. 9 (15.0%) cases, p=0.023). Median overall survival was 15 and 14 months, respectively. Overall five-year survival was 24.1% (95% CI 7.8-45.2) and 8.2% (95% CI 2.3-18.9%), respectively (p=0.483). Locoregional recurrence was more common in the 2^nd group (23 (41.8%) out of 55 vs. 3 (13.6%) out of 23 patients, p=0.018). In the 1^st group, median overall survival without adjuvant chemotherapy was 13 months (95% CI 5-17), in the group with adjuvant chemotherapy - 37 months (95% CI 14-64). Overall five-year survival was 7.7% (95% CI 5-29.2) and 50.0% (95% CI 13.7-78.5), respectively (p=0.003). Median overall survival in the 2^nd group without adjuvant chemotherapy was 13 months (95% CI 5-17), in the 2^nd group with chemotherapy - 17 months (95% CI 12-29; p=0.016). The risk of death in the 2^nd group with chemotherapy was lower than in the 1^st group without chemotherapy (OR 0.385; 95% CI 0.183-0.809; p=0.012). Multivariate analysis in the 1^st group revealed that ASA class 3 negatively affected overall survival (OR 3.04; 95% CI 1.04-8.81; p=0.040). Multivariate analysis after combining both groups established that negative factors of long-term prognosis were female gender (OR 2.47; 95% CI 1.25-4.87; p=0.009), coronary artery disease (OR 3.44; 95% CI 1.16-10.17; p=0.025), locoregional recurrence (OR 2.49; 95% CI 1.13-5.50; p=0.024) and type B pancreatic fistula (OR 2.68; 95% CI 1.070-6.731; p=0.035). Positive factors were multivisceral surgeries with pancreaticoduodenectomy (OR 0.36; 95% CI 0.14-0.86; p=0.023) and adjuvant chemotherapy (OR 0.27; 95% CI 0.13-0.57; p<0.001).

Multivisceral surgeries with pancreaticoduodenectomy for gastric cancer with pancreatic and/or duodenal invasion is justified in patients with ASA class 1-2 due to higher probability of adjuvant chemotherapy and better survival.