Extended surgery--left upper abdominal exenteration plus Appleby's method--for type 4 gastric carcinoma

Area of Science:

• Surgical Oncology
• Gastrointestinal Surgery
• Gastric Cancer Research

Background:

• Type 4 gastric cancer, including linitis plastica, has a poor prognosis with frequent retroperitoneal recurrence.
• Extended surgery, left upper abdominal exenteration plus the Appleby's method (LUAE + Apl), has been used for type 4 cancers since 1983 to achieve complete tumor removal.
• The study evaluates the efficacy of LUAE + Apl for advanced gastric cancer.

Purpose of the Study:

• To evaluate the outcomes of extended surgery (LUAE + Apl) for type 4 gastric cancer.
• To compare the survival rates of patients undergoing LUAE + Apl with those who had conventional surgery.
• To identify the optimal application of the LUAE + Apl procedure.

Main Methods:

• A total of 54 patients with type 4 gastric cancer underwent LUAE + Apl.
• The LUAE + Apl procedure involves en bloc removal of the stomach, pancreas, spleen, gallbladder, transverse colon, and left adrenal gland.
• Patient outcomes were compared between the extended surgery group (Group A) and a historical control group (Group B) who underwent common surgery.

Main Results:

• Postoperative complications included pancreatic fistula (30% vs. 19% in controls) and liver dysfunction (15% vs. 14%).
• The 5-year survival rate for stage III patients in Group A (40%) was significantly better than in Group B (20%; p < 0.05).
• For stage IV patients, the 5-year survival rate was not improved by LUAE + Apl (5% in Group A vs. 3% in Group B).

Conclusions:

• LUAE + Apl improves survival for stage III scirrhous gastric cancer.
• This extended surgical approach is not effective for improving survival in stage IV gastric cancer.
• Novel treatment concepts and supportive therapies are required to enhance survival for stage IV gastric cancer patients.