P-262 Multivisceral resections for gastric cancer - Should all patients with locally-disease receive them?

Abstract

Introduction: Multivisceral resections for gastric cancer have been associated with worse postoperative morbidity and mortality and inferior survival outcomes in the literature, but they remain the lone curative option in locally-advanced disease. The aim of this study was to identify prognostic factors that could select patients that would benefit the most from these resections. Methods: This is a retrospective study which included 205 gastric cancer patients treated with a multivisceral resection in a single cancer center in the period between January 1988 and December 2014. Prognostic factors for postoperative morbidity and mortality were researched in the whole population and survival prognostic factors in 149 subjects who were treated with curative intent. A score was determined from the Hazard-ratios obtained through multiple analyses. Results: Most of the patients were male (63%) and their median age was 62 years old. Surgery was a total gastrectomy in 169 individuals and a distal resection in 36. It was performed with a curative intent in 149 subjects, while the other 56 had a noncurative resection. The most common associated resection was a splenectomy, in 167, a pancreatectomy, in 58 and a colectomy, in 28. Overall morbidity was 44.9%, with pneumonia (13.2%) and abdominal abscess (12.7%) the most frequent complications. Overall 60-day mortality was 11.2%. The independent factors that influenced morbidity were blood transfusion, total gastrectomy and age. Median follow-up for living patients was 73 months. Patients who were treated with curative intent had a median survival of 24 months and a 5-year survival of 35.6%. Median survival of those who had a noncurative resection was 7 months. Blood transfusion, weight loss > 10% and N-stage were negative predictors of survival. The score obtained from these three variables identified three groups with very distinct survival numbers. Median survival was not achieved among those with scores 3-4, it was 37 months with scores 5-6 and 11 months with score 7. Conclusion: Multivisceral resections for gastric cancer are associated with higher morbidity and mortality and worse survival, although with a significant 5-year survival for locally advanced disease. The prognostic score obtained showed that patients who have weight loss > 10%, advanced lymph node disease and receive blood transfusion show survival outcomes that are similar to metastatic patients ones.