Impact of Pancreatic Resection on Survival in Locally Advanced Resectable Gastric Cancer

Abstract

Whether gastric adenocarcinoma (GC) patients with adjacent organ invasion (T4b) benefit from aggressive surgery involving pancreatic resection (PR) remains unclear. This study aimed to clarify the impact of PR on survival in patients with locally advanced resectable GC. Between 1995 and 2017, patients with locally advanced GC undergoing radical-intent gastrectomy with and without PR were enrolled and stratified into four groups: group 1 (G1), pT4b without pancreatic resection (PR); group 2 (G2), pT4b with PR; group 3 (G3), positive duodenal margins without Whipple’s operation; and group 4 (G4), cT4b with Whipple’s operation. Demographics, clinicopathological features, and outcomes were compared between G1 and G2 and G3 and G4. G2 patients were more likely to have perineural invasion than G1 patients (80.6% vs. 50%, p < 0.001). G4 patients had higher lymph node yield (40.8 vs. 31.3, p = 0.002), lower nodal status (p = 0.029), lower lymph node ratios (0.20 vs. 0.48, p < 0.0001) and higher complication rates (45.2% vs. 26.3%, p = 0.047) than G3 patients. The 5-year disease-free survival (DFS) and overall survival (OS) rates were significantly longer in G1 than in G2 (28.1% vs. 9.3%, p = 0.003; 32% vs. 13%, p = 0.004, respectively). The 5-year survival rates did not differ between G4 and G3 (DFS: 14% vs. 14.4%, p = 0.384; OS: 12.6% vs. 16.4%, p = 0.321, respectively). In conclusion, patients with T4b lesion who underwent PR had poorer survival than those who underwent resection of other adjacent organs. Further Whipple’s operation did not improve survival in pT3–pT4 GC with positive duodenal margins.

Short-term safety and Long-term efficacy of multivisceral resection in pT4b gastric cancer patients without distant metastasis: a 20-year experience in China National Cancer Center

“…In the present study, the 5-year OS rate of pT4b GC patients who received MVR surgery was 39.1%, which was a little higher than the previous results. This may be related to the fact that the previous results have illustrated that prognosis in the patients combined with pancreas resection, especially in patients who underwent pancreaticoduodenectomy, was poor than patients combined other organs resection during MVR surgery 3 , 10 , 11 . In a Korea retrospective study, the 5-year OS rates of pT4b patients combined pancreas resection group and combined other organs resection were 23.3% and 42.1% ( P =0.002), while in the pancreaticoduodenectomy group, the 5-year OS rates was 0% 11 .…”

“…Although Tran et al found that MVR surgery with pancreas resection was not associated with an increased frequency of postoperative complications and mortality 10 . The gastrectomy combined with pancreaticoduodenectomy was considered to have high risk of postoperative death and complications 3 , 10 . Thirdly, the number of cases in the present study and previous studies were relatively small, which could potentially bias the results.…”

“…Gastric cancer (GC) is one of the most common fatal malignancies with high risk of metastasis and tumor recurrence 1 . Considering that locally advanced GC sometimes invade the surrounding organs (T4b), such as pancreas, colon, and liver 2 , the multivisceral resection (MVR) surgery is necessary to achieve a negative margin 3 , 4 . Generally, MVR surgery is considered to have higher cost with increased risk of postoperative complications and mortality 5 .…”

“…To date, only a few studies evaluated the safety and efficacy of MVR surgery focusing on pathologic T4b (pT4b) patients 3 , 6 , 11 . In Korea Cancer Center Hospital, 243 GC patients with pT4b were retrospectively reviewed, and the results demonstrated that the postoperative mortality rate was 0.8% and the media overall survival (OS) was 26 months 11 .…”

Outcomes of Conversion Surgery for Metastatic Gastric Cancer Compared with In-Front Surgery Plus Palliative Chemotherapy or In-Front Surgery Alone

“…Our data also showed that in-front surgery alone had significantly higher rates of mortality/complications and shorter OS time than conversion surgery or in-front surgery plus PCT, indicating that systemic treatment is the standard of care for mGC. Postoperative complications are independent risk factors for the early recurrence of GC after curative resection, which is related to the inflammatory cytokine cascade-induced dysfunction of immune cells, including cytotoxic T-lymphocytes, natural killer cells, and antigen-presenting cells, and a delay in the initiation of postoperative chemotherapy [30][31][32]. Postoperative complications and surgery-related immune suppression are major concerns in in-front surgery for mGC.…”