Appropriate Selection of Patients for Combined Organ Resection in Cases of Gastric Carcinoma Invading Adjacent Organs

Background and Objectives: Proper patient selection for multi-organ resection in T4 gastric carcinoma remains controversial. Our aim was to investigate which patient,. might benefit front multi-organ resection. Methods: Among 1,775 consecutive patients receiving gastric cancer surgery, 71 had adjacent Organ invasion. Short- and long-term surgical outcomes and associations between clinicopathological factors and overall survival were investigated. Results: Forty-seven patients underwent curative surgery with multi-organ resection, and 24 underwent non-curative surgery, with or without multi-organ resection. Postoperative morbidity and mortality rates were 31.7% and 3.3%. respectively. Patients receiving curative surgery via multi-organ resection survived longer than those without (MST, 31.5 months vs. 19.1 months, P = 0.046). Multi-organ resection did not affect survival when performed in non-curative surgery. N3 lymph node metastasis was an independent prognostic factor for poor outcome (HR = 3.89. 95% CI = 1.40-10.83) in curatively resected patients; patients with N3 lymph node metastasis showed similar survival to patients receiving non-curative surgery. Conclusion: Multi-organ resection should be performed only when no incurable factors are present, and R0 resection is most likely. Multi-organ organ resection does not. however, seem to be effective in patients with N3 lymph node metastasis. even when curative resection is performed. J. Surg. Oncol. 2009:100:115-120. (C) 2009 Wiley-Liss, Inc.