Prognosis of T4 gastric carcinoma patients: An appraisal of aggressive surgical treatment

Background and Objectives: Despite precipitous drop in the incidence of gas tric carcinoma in Japan, it is still one of the leading causes of death ass ociated with malignant disease. Once the contiguous organs ale involved the prognosis becomes dismal. Prognostic factors governing the survival of pat ients with T4 gastric carcinoma remain unclear. Methods: Between 1980 and 1998, 150 patients were treated for T4 gastric ca rcinoma. Results and prognostic factors were evaluated by univariate and mu ltivariate analyses. Results: With a 73% respectability, patients with tumor resection had a sig nificantly (P < 0.0001) improved survival rate. Within an acceptable operat ive mortality (2.6%) apparently curative cases had survival benefit (P < 0. 0001) over noncurative cases. In the multivariate analysis, the death risk increased by 2.18 (relative risk) when splenectomy was spared from the oper ative procedure (P < 0.0071). Presence of esophageal invasion was the other independent prognostic factor in T-l gastric carcinoma patients (relative risk 2.11). Conventional prognostic factors along with the type of organs i nvaded by the carcinoma had no impact on prognosis. Conclusions: Patients with T4 gastric carcinoma might be benefited from agg ressive surgery with a curative intent. Whenever possible, splenectomy shou ld be done along with invaded organ resection. (C) 2001 Wiley-Liss, Inc.