Combined resection of invaded organs in patients with T4 gastric carcinoma

Saito, Hiroaki; Tsujitani, Shunichi; Maeda, Yuichi; Fukuda, Kenji; Yamaguchi, Kensei; Ikeguchi, Masahide; Maeta, Michio; Kaibara, Nobuaki

doi:10.1007/s10120-001-8011-y

Cited by 45 publications

(59 citation statements)

References 5 publications

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“…Eight studies reported their ability to achieve a complete resection (R0), with results ranging from 38 to 100%, suggesting that a significant proportion of patients have positive microscopic or macroscopic margins despite undergoing MVR [1, 2, 7-9, 11, 17, 19]. Survival in patients who underwent MVR without a complete resection was demonstrated to be significantly diminished compared to those who had an R0 resection [2,9,11,18]. Poor outcomes appear to be associated with both microscopic and macroscopic positive margins [12,15].…”

Section: Discussionmentioning

confidence: 99%

“…Four studies reported a statistically significant survival advantage when MVR was performed with an R0 resection compared to R? resection [2,9,11,18]. Table 5 lists the studies that reported survival based on the number of organs involved or resected.…”

Section: Literature Searchmentioning

confidence: 99%

“…After removal of duplicates and screening for relevant titles and abstracts, a total of 142 articles were submitted for a full-text review. Seventeen studies involving 1343 patients met our inclusion criteria and were included in this review [1,2,[4][5][6][8][9][10][11][12][13][14][15][16][17][18][19][20] (Fig. 1).…”

Section: Literature Searchmentioning

confidence: 99%

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Multivisceral resection for gastric cancer: a systematic review

et al. 2011

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Background The overall prognosis and survival of patients with advanced gastric cancer is generally poor. One of the most powerful predictors of outcomes in gastric cancer surgery is an R0 resection. However, the extent of the required surgical resection and the additional benefit of multivisceral resection (MVR) are controversial. Methods Electronic literature searches were conducted using Medline, EMBASE, and the Cochrane Central Register of Controlled Trials from

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Section: Discussionmentioning

confidence: 99%

Section: Literature Searchmentioning

confidence: 99%

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Multivisceral resection for gastric cancer: a systematic review

et al. 2011

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“…The prognostic importance of lymph node involvement has been examined in many series of multivisceral resections (other than PD) for gastric cancer [6,21,[25][26][27][28], with most finding no survival benefit for extended resections in patients with extensive lymph node involvement. However, in a few series [29], even in patients with advanced nodal disease, a benefit was found for multivisceral resection.…”

Section: Discussionmentioning

confidence: 98%

Systematic review of pancreaticoduodenectomy for locally advanced gastric cancer

et al. 2011

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Background The purpose of this study was to identify and synthesize findings from all articles on surgical and longterm outcomes in patients with gastric cancer undergoing gastrectomy combined with pancreaticoduodenectomy (PD). Methods Electronic literature searches were conducted using Medline, EMBASE, and Cochrane databases from January 1, 1985, to December 31, 2009. Results Eight retrospective case series were included, with 132 patients having PD combined with gastrectomy. PD was combined with total gastrectomy in 27 patients, and subtotal gastrectomy in 81 patients; 24 patients had undocumented gastric resection type. Clinical stage was available for 92 patients (4 stage I, 7 stage II, 26 stage III, and 55 stage IV). Five studies (98 patients having PD combined with gastrectomy) compared PD and gastrectomy to gastrectomy alone. In the four studies reporting morbidity, PD had a higher morbidity. The pooled pancreatic anastomotic leak rate was 24.5% for the seven studies in which complications were reported; however, there were no peri-operative deaths. Long-term survival (37.3% at 5 years) in gastric cancer patients with PD combined with gastrectomy was described; however, survival was poor in the setting of incurable factors. Due to heterogeneity of patients and staging techniques in the case series no recommendations can be made on the appropriate selection criteria for patients undergoing PD and gastrectomy. Conclusion PD for gastric cancer invading the pancreas is associated with a higher morbidity; given the heterogeneous data, defining exact selection criteria is difficult.

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“…In patients with T4 gastric cancer, the 5-year survival rate after curative surgery is only 16.8%-32.2% [13][14][15][16][17]. Despite the low survival rates, many authors recommend surgical resection, which is the only option for the long-term survival of these patients.…”

Section: Discussionmentioning

confidence: 99%

Advanced gastric cancer with a duplicated hepatic artery: preoperative diagnostic value of multidetector-row computed tomography for surgical resection

et al. 2007

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In patients with T4 gastric cancer, curative surgery can be achieved with concomitant resection of the invaded organs. However, curative resection is not necessarily possible in all cases. In patients with advanced gastric cancer with infi ltration of the pancreatic head and common hepatic artery (CHA), curative surgery is usually impossible, because pancreaticoduodenectomy (PD) with CHA resection leads to an abrupt reduction in the arterial blood supply to the liver and results in severe liver damage. We experienced a case of advanced gastric cancer that infi ltrated these organs, i.e., the pancreatic head and CHA. We were able to perform curative surgery in this patient because preoperative multidetector-row computed tomography (MDCT) revealed the presence of a duplicated hepatic artery. Here, we present a very rare case of advanced gastric cancer in a patient with a duplicated hepatic artery, and we note the value of MDCT for preoperative diagnosis. Case reportA 63-year-old Japanese woman presented to her family physician with appetite loss and general fatigue in June 2003. Gastrointestinal fi berscopy and upper gastrointestinal (GI) series revealed type 2 advanced gastric cancer in the antrum, with pyloric stenosis and duodenal invasion (Fig. 1). The patient was referred to the Cancer Institute Hospital for further examination. Laboratory examination revealed severe anemia (hemoglobin, 8.0 g/ dl) and poor nutritional condition (albumin, 3.3 g/dl). Abdominal MDCT revealed massive gastric cancer directly invading the left hepatic lobe and pancreatic head as well as vascular anomaly. Metastasized lymph nodes also invaded the CHA directly (Fig. 2). Although paraaortic lymph nodes were identifi ed, CT did not reveal any distant metastasis. In general, PD with CHA resection is considered to be impossible, because it Abstract A 63-year-old woman with appetite loss and general fatigue underwent gastrointestinal fi berscopy, which revealed type 2 advanced gastric cancer. Multidetector-row computed tomography revealed a massive gastric cancer invading the left hepatic lobe, pancreatic head, and common hepatic artery, as well as revealing a duplicated hepatic artery in which the right hepatic artery branched directly from the celiac axis, and ran behind the splenic vein. On the other hand, the common hepatic artery ran anterior to the splenic vein. We were able to perform pancreaticoduodenectomy with common hepatic artery resection and left lobectomy as curative surgery because her duplicated hepatic artery enabled us to ligate the common hepatic artery. Her postoperative clinical course was uneventful, and she is in good health 3 years after the surgery, without recurrence. We consider that multidetector-row computed tomography is very useful for the diagnosis of vascular anomaly, preoperative staging and decision making on the appropriate surgical strategy.

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Combined resection of invaded organs in patients with T4 gastric carcinoma

Cited by 45 publications

References 5 publications

Multivisceral resection for gastric cancer: a systematic review

Multivisceral resection for gastric cancer: a systematic review

Systematic review of pancreaticoduodenectomy for locally advanced gastric cancer

Advanced gastric cancer with a duplicated hepatic artery: preoperative diagnostic value of multidetector-row computed tomography for surgical resection

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