MULTIVISCERAL RESECTIONS FOR GASTRIC CANCER

Abstract

BACKGROUND: Multivisceral resection for locally advanced gastric cancer is necessary to achieve R0-margins. This surgical option is accompanied by short- and long-term outcomes that still remain questionable. AIM: Our aim was to evaluate the efficacy of "en bloc"-resections as an "aggressive" surgical approach with regard to postoperative morbidity, mortality and survival. MATERIAL AND METHODS: Postoperative morbidity, mortality and survival rates of 60 patients with locally advanced gastric carcinoma, who underwent total or subtotal gastrectomy with multivisceral resection between 2004-2014, were retrospectively analysed. RESULTS: The most common adjacent organs resected were spleen (n = 46) - 76.7%, pancreas (n = 24) - 40%, colon (n = 11) - 18.3%, liver (n = 9) - 15% and duodenum (n = 4) - 6.7%. Resection of more than one organ was performed in 70% of cases, R0-resection was achieved in 75%, histopathologic examination confirmed involvement of adjacent organs (pT4) in 42 patients (70%). Surgical mortality and morbidity rates were 6.7% and 28.3% respectively. The overall 5-year survival rate was 24.1% (R0 vs R1 resections - 32.6 vs 0%, p < 0.05). There is a 10-year survival rate of 5.2% registered. CONCLUSION: R0-multivisceral resection is the key therapeutic option for advanced gastric cancer. It appears to be feasible in selected patients on providing adequate selection and surgical expertise and can be achieved with relatively low mortality and morbidity, offering good overall and 5-year survival rates.