Retrospective analysis of surgically treated pT4b gastric cancer with pancreatic head invasion

Peng Jin; Hao Liu; Fu-Hai Ma; Shuai Ma; Yang Li; Jian-Ping Xiong; Wen-Zhe Kang; Hai-Tao Hu; Yan-Tao Tian

doi:10.12998/wjcc.v9.i29.8718

Retrospective analysis of surgically treated pT4b gastric cancer with pancreatic head invasion

World J Clin Cases. 2021 Oct 16;9(29):8718-8728. doi: 10.12998/wjcc.v9.i29.8718.

Authors

Peng Jin¹, Hao Liu¹, Fu-Hai Ma¹, Shuai Ma¹, Yang Li¹, Jian-Ping Xiong¹, Wen-Zhe Kang¹, Hai-Tao Hu¹, Yan-Tao Tian²

Affiliations

¹ Department of Pancreatic and Gastric Surgery, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100021, China.
² Department of Pancreatic and Gastric Surgery, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100021, China. tianyantao@cicams.ac.cn.

Abstract

Background: For advanced gastric cancer patients with pancreatic head invasion, some studies have suggested that extended multiorgan resections (EMR) improves survival. However, other reports have shown high rates of morbidity and mortality after EMR. EMR for T4b gastric cancer remains controversial.

Aim: To evaluate the surgical approach for pT4b gastric cancer with pancreatic head invasion.

Methods: A total of 144 consecutive patients with gastric cancer with pancreatic head invasion were surgically treated between 2006 and 2016 at the China National Cancer Center. Gastric cancer was confirmed in 76 patients by postoperative pathology and retrospectively analyzed. The patients were divided into the gastrectomy plus en bloc pancreaticoduodenectomy group (GP group) and gastrectomy alone group (GA group) by comparing the clinicopathological features, surgical outcomes, and prognostic factors of these patients.

Results: There were 24 patients (16.8%) in the GP group who had significantly larger lesions (P < 0.001), a higher incidence of advanced N stage (P = 0.030), and less neoadjuvant chemotherapy (P < 0.001) than the GA group had. Postoperative morbidity (33.3% vs 15.3%, P = 0.128) and mortality (4.2% vs 4.8%, P = 1.000) were not significantly different in the GP and GA groups. The overall 3-year survival rate of the patients in the GP group was significantly longer than that in the GA group (47.6%, median 30.3 mo vs 20.4%, median 22.8 mo, P = 0.010). Multivariate analysis identified neoadjuvant chemotherapy [hazard ratio (HR) 0.290, 95% confidence interval (CI): 0.103-0.821, P = 0.020], linitis plastic (HR 2.614, 95% CI: 1.024-6.675, P = 0.033), surgical margin (HR 0.274, 95% CI: 0.102-0.738, P = 0.010), N stage (HR 3.489, 95% CI: 1.334-9.120, P = 0.011), and postoperative chemoradiotherapy (HR 0.369, 95% CI: 0.163-0.836, P = 0.017) as independent predictors of survival in patients with pT4b gastric cancer and pancreatic head invasion.

Conclusion: Curative resection of the invaded pancreas should be performed to improve survival in selected patients. Invasion of the pancreatic head is not a contraindication for surgery.

Keywords: Extended multiorgan resection; Gastric cancer; Pancreatectomy; Prognostic factors; R0 resection; T4.