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Annals of Surgical Oncology
Published in: Annals of Surgical Oncology 6/2011

01-06-2011 | Gastrointestinal Oncology

Aggressive Surgical Approach for Patients with T4 Gastric Carcinoma: Promise or Myth?

Authors: Chi-Tung Cheng, MD, Chun-Yi Tsai, MD, Jun-Te Hsu, MD, Rohan Vinayak, MD, Keng-Hao Liu, MD, Chun-Nan Yeh, MD, Ta-Sen Yeh, MD, PhD, Tsann-Long Hwang, MD, Yi-Yin Jan, MD

Published in: Annals of Surgical Oncology | Issue 6/2011

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Abstract

Background

Surgical outcomes of multiorgan resection (MOR) for T4 gastric carcinoma reported in the literature are widely variable. We herein report a large surgical series of T4 gastric carcinoma.

Methods

One hundred seventy-nine patients with cT4 gastric carcinoma were recruited onto the study. Patient characteristics, surgical strategy and related complications, long-term survival, and prognostic factors of T4 gastric carcinoma were analyzed.

Results

Of 179 cT4 gastric carcinoma, there were 57 cT4 (pT3) with MOR, 91 pT4 with MOR, and 31 cT4 without MOR. pT4 with MOR were more likely to be associated with nodal metastasis, cellular dedifferentiation, and lymphoperineural infiltration compared to those of pT0–3 (P < 0.01 for all). For 91 pT4 with MOR, their surgical mortality and morbidity rates were 4.4 and 28.6%, respectively; their 1-, 3-, and 5-year overall survival rates were 55.2, 22.4, and 12.2%, respectively. The long-term survival of cT4 (pT3) with MOR was superior to pT4 with MOR (P = 0.006) and cT4 without MOR (P = 0.004). There was a striking difference between pT4 with MOR, R0 and pT4 with MOR, and R1 or R2 (P = 0.007). By means of multivariate analysis, lymph node status, liver invasion, and positive surgical margin were independent prognostic factors.

Conclusions

Aggressive surgical management of pT4 gastric carcinoma should be limited to patients without adverse prognostic factors such as advanced nodal involvement and pancreatic invasion.
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Metadata
Title
Aggressive Surgical Approach for Patients with T4 Gastric Carcinoma: Promise or Myth?
Authors
Chi-Tung Cheng, MD
Chun-Yi Tsai, MD
Jun-Te Hsu, MD
Rohan Vinayak, MD
Keng-Hao Liu, MD
Chun-Nan Yeh, MD
Ta-Sen Yeh, MD, PhD
Tsann-Long Hwang, MD
Yi-Yin Jan, MD
Publication date
01-06-2011
Publisher
Springer-Verlag
Published in
Annals of Surgical Oncology / Issue 6/2011
Print ISSN: 1068-9265
Electronic ISSN: 1534-4681
DOI
https://doi.org/10.1245/s10434-010-1534-x

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