EXTENDED SURGICAL RESECTION IN T-4 GASTRIC-CANCER

BACKGROUND: Some physicians still consider invasion of adjacent organs by the carcinoma of stomach as a sign of incurable disease. METHODS: This retrospective study has been done with particular reference to 35 3 T-4 gastric cancer patients who underwent combined gastrectomies wit h adjacent organs. RESULTS: Subtotal gastrectomy was performed in 237 (67.1%) patients and total gastrectomy was performed in 116 (32.9%) pa tients. Organs most commonly resected with the stomach were the transv erse colon in 159 (45%) cases, the tail of pancreas and spleen in 150 (42.5%), the left lobe of liver in 101 (28.5%), and the head of pancre as in 37 (10.5%) patients. A total of 110 postoperative complications occurred in this subset of patients corresponding to a complication ra te of 31.2%. A total of 48 postoperative deaths occurred in this subse t of patients corresponding to a mortality rate of 13.6%. The 5-year s urvival rate for all patients who underwent combined gastrectomy with adjacent organs was 25%. Of the node-negative T-4 gastric cancer resec tions, 37% survived 5 years whereas the T-4 node-positive resections h ave only a 15% 5-year survival. CONCLUSIONS: Patients who present with T-4 gastric cancer (about 20% of the patient population) will benefit from aggressive on bloc surgical resection and should not be consider ed unresectable. (C) 1998 by Excerpta Medica, Inc.