Impact of Pancreatic Resection on Survival in Locally Advanced Resectable Gastric Cancer
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, patien...
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| Format: | Article |
| Language: | English |
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MDPI AG
2021-03-01
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| Series: | Cancers |
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| Online Access: | https://www.mdpi.com/2072-6694/13/6/1289 |
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| author | Shih-Chun Chang Chi-Ming Tang Puo-Hsien Le Chia-Jung Kuo Tsung-Hsing Chen Shang-Yu Wang Wen-Chi Chou Tse-Ching Chen Ta-Sen Yeh Jun-Te Hsu |
| author_facet | Shih-Chun Chang Chi-Ming Tang Puo-Hsien Le Chia-Jung Kuo Tsung-Hsing Chen Shang-Yu Wang Wen-Chi Chou Tse-Ching Chen Ta-Sen Yeh Jun-Te Hsu |
| author_sort | Shih-Chun Chang |
| collection | DOAJ |
| description | 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%, <i>p</i> < 0.001). G4 patients had higher lymph node yield (40.8 vs. 31.3, <i>p</i> = 0.002), lower nodal status (<i>p</i> = 0.029), lower lymph node ratios (0.20 vs. 0.48, <i>p</i> < 0.0001) and higher complication rates (45.2% vs. 26.3%, <i>p</i> = 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%, <i>p</i> = 0.003; 32% vs. 13%, <i>p</i> = 0.004, respectively). The 5-year survival rates did not differ between G4 and G3 (DFS: 14% vs. 14.4%, <i>p</i> = 0.384; OS: 12.6% vs. 16.4%, <i>p</i> = 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. |
| first_indexed | 2024-03-10T13:15:56Z |
| format | Article |
| id | doaj.art-e7061dca8d3c472a83d0eda84d15a4f4 |
| institution | Directory Open Access Journal |
| issn | 2072-6694 |
| language | English |
| last_indexed | 2024-03-10T13:15:56Z |
| publishDate | 2021-03-01 |
| publisher | MDPI AG |
| record_format | Article |
| series | Cancers |
| spelling | doaj.art-e7061dca8d3c472a83d0eda84d15a4f42023-11-21T10:27:48ZengMDPI AGCancers2072-66942021-03-01136128910.3390/cancers13061289Impact of Pancreatic Resection on Survival in Locally Advanced Resectable Gastric CancerShih-Chun Chang0Chi-Ming Tang1Puo-Hsien Le2Chia-Jung Kuo3Tsung-Hsing Chen4Shang-Yu Wang5Wen-Chi Chou6Tse-Ching Chen7Ta-Sen Yeh8Jun-Te Hsu9Department of General Surgery, Chang Gung Memorial Hospital at Linkou, Chang Gung University College of Medicine, Taoyuan 333, TaiwanDepartment of General Surgery, Chang Gung Memorial Hospital at Linkou, Chang Gung University College of Medicine, Taoyuan 333, TaiwanDepartment of Gastroenterology, Chang Gung Memorial Hospital at Linkou, Chang Gung University College of Medicine, Taoyuan 333, TaiwanDepartment of Gastroenterology, Chang Gung Memorial Hospital at Linkou, Chang Gung University College of Medicine, Taoyuan 333, TaiwanDepartment of Gastroenterology, Chang Gung Memorial Hospital at Linkou, Chang Gung University College of Medicine, Taoyuan 333, TaiwanDepartment of General Surgery, Chang Gung Memorial Hospital at Linkou, Chang Gung University College of Medicine, Taoyuan 333, TaiwanDepartment of Hematology-Oncology, Chang Gung Memorial Hospital at Linkou, Chang Gung University College of Medicine, Taoyuan 333, TaiwanDepartment of Pathology, Chang Gung Memorial Hospital at Linkou, Chang Gung University College of Medicine, Taoyuan 333, TaiwanDepartment of General Surgery, Chang Gung Memorial Hospital at Linkou, Chang Gung University College of Medicine, Taoyuan 333, TaiwanDepartment of General Surgery, Chang Gung Memorial Hospital at Linkou, Chang Gung University College of Medicine, Taoyuan 333, TaiwanWhether 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%, <i>p</i> < 0.001). G4 patients had higher lymph node yield (40.8 vs. 31.3, <i>p</i> = 0.002), lower nodal status (<i>p</i> = 0.029), lower lymph node ratios (0.20 vs. 0.48, <i>p</i> < 0.0001) and higher complication rates (45.2% vs. 26.3%, <i>p</i> = 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%, <i>p</i> = 0.003; 32% vs. 13%, <i>p</i> = 0.004, respectively). The 5-year survival rates did not differ between G4 and G3 (DFS: 14% vs. 14.4%, <i>p</i> = 0.384; OS: 12.6% vs. 16.4%, <i>p</i> = 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.https://www.mdpi.com/2072-6694/13/6/1289gastric adenocarcinomamultiorgan resectionpancreatic resectionsurvival |
| spellingShingle | Shih-Chun Chang Chi-Ming Tang Puo-Hsien Le Chia-Jung Kuo Tsung-Hsing Chen Shang-Yu Wang Wen-Chi Chou Tse-Ching Chen Ta-Sen Yeh Jun-Te Hsu Impact of Pancreatic Resection on Survival in Locally Advanced Resectable Gastric Cancer Cancers gastric adenocarcinoma multiorgan resection pancreatic resection survival |
| title | Impact of Pancreatic Resection on Survival in Locally Advanced Resectable Gastric Cancer |
| title_full | Impact of Pancreatic Resection on Survival in Locally Advanced Resectable Gastric Cancer |
| title_fullStr | Impact of Pancreatic Resection on Survival in Locally Advanced Resectable Gastric Cancer |
| title_full_unstemmed | Impact of Pancreatic Resection on Survival in Locally Advanced Resectable Gastric Cancer |
| title_short | Impact of Pancreatic Resection on Survival in Locally Advanced Resectable Gastric Cancer |
| title_sort | impact of pancreatic resection on survival in locally advanced resectable gastric cancer |
| topic | gastric adenocarcinoma multiorgan resection pancreatic resection survival |
| url | https://www.mdpi.com/2072-6694/13/6/1289 |
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