Multivisceral resections for T4 gastric cancer.

Introduction: Background: Multiple organ resection for locally advanced (T4) gastric cancer (AGC) is associated with high morbidity and mortality and poor outcome. Our aim was to evaluate the efficacy of these surgeries with regard to surgical morbidity, mortality and survival. Methods: Methods: Was analyzed medical records of 1055 patients with AGC underwent total or subtotal gastrectomy with multivisceral resection and D2 or D3 lymphatic dissection between 1998 – 2016 years, at the Clinic of National Cancer Institute (Ukraine). Results: Results: Structure of AGC spreading: colon – 46.4%; pancreatic body/tail and spleen – 45.3%; pancreatic head – 12.6%; hepatic left lobe – 26%. Gastrectomy with resection of three and more adjacent organs – 22.1%; two organs - 24%, one organ – 54%. Surgical mortality and morbidity rate were 6,8% and 23,9% respectively. Main causes of postoperative mortality were pancreatic necrosis (4,5%) and abdominal abscesses (2,6%). The overall 5-year survival rate was 25%. Survival of patients with R0 and R1 resections was 37% and 13% respectively (p < 0,05). Histopathologic examination confirmed involvement of adjacent organs (pT4) in 89,2% of multivisceral resection cases, other 10,8% invasions were mimicking by desmoplastic tumor reaction (pT3) without differences in long term outcome in both groups. Conclusion: Conclusions: Complete tumor R0 resection, including adjacent organs, is the key to successful treatment for AGC. Aggressive multivisceral resection for AGC is technically feasible and can be achieve with low mortality and acceptable morbidity, offering good disease free and overall survival.