Impact of Combined Resection of the Pancreas on Long-Term Survival in Gastric Cancer

In patients with advanced gastric cancer invading adjacent organs, extended multivisceral resection is required to achieve R0 resection. However, the survival benefit of combined gastrectomy and pancreatic resection remains controversial. This study aimed to investigate the safety and efficacy of combined gastrectomy and pancreatectomy for gastric cancer.

This study retrospectively included 64 patients who underwent pancreaticoduodenectomy (PD) or distal pancreatectomy with splenectomy (DP) for primary gastric cancer with invasion of the pancreas by the primary tumor, from lymph node metastasis or via duodenal invasion.

PD was performed in 18 patients (28%) and DP in 46 (72%). Macroscopic invasion of the pancreas from the primary tumor was observed in 47 patients (73%), from lymph nodes in 13 (20%) and via duodenal invasion in four (6%). Pathological pancreatic invasion was observed in 27 patients (57%). Morbidity due to postoperative intra-abdominal infectious complications (PIICs) of Clavien-Dindo Grade III or higher was observed in 33 patients (52%). Multivariate analysis showed that duodenal invasion was an independent risk factor for PIICs (p = 0.039). Surgery resulted in R1 resection in 12 patients (18%). Multivariate analysis identified R1 resection (hazard ratio (HR): 5.315, p < 0.001) and PIICs (HR: 2.067, p = 0.027) as independent prognostic factors for overall survival. Multivariate analysis of relapse-free survival identified PIICs as an independent prognostic factor (HR: 2.345, p = 0.036).

Pancreatic resection is considered safe and effective in patients with pancreatic or duodenal invasion from gastric cancer when R0 resection is possible.