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Selection of best candidates for multiorgan resection among patients with T4 gastric carcinoma
Author(s) -
OñateOcaña Luis F.,
Becker Mauricio,
Carrillo José F.,
AielloCrocifoglio Vincenzo,
GallardoRincón Dolores,
BromValladares Rocío,
HerreraGoepfert Roberto,
OchoaCarrillo Francisco,
BeltránOrtega Arturo
Publication year - 2008
Publication title -
journal of surgical oncology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.201
H-Index - 111
eISSN - 1096-9098
pISSN - 0022-4790
DOI - 10.1002/jso.21118
Subject(s) - medicine , hazard ratio , gastrectomy , proportional hazards model , confidence interval , gastroenterology , ascites , surgery , cohort , carcinoma , albumin , cancer
Background and Objective Indications for gastrectomy in T4 gastric carcinoma (GC) remain controversial. Our aim was to define prognostic factors to select those patients with best chance to benefit from multiorgan resection. Materials and Methods A cohort of patients with T4 GC treated in a 19‐year period. Surgical morbidity‐associated factors were identified by logistic regression analysis. Prognostic factors were defined by Kaplan–Meier and Cox methods. Results Seven hundred eighteen patients were included (gastrectomy performed in 169). Surgical morbidity and mortality were 39% and 10.7%, respectively. Surgical morbidity were associated to extent of gastrectomy, age, serum albumin, and lymphocyte count ( P = 0.0001). Presence of metastasis (hazard ratio [HR], 1.68; 95% confidence interval [95% CI], 1.19–2.36), albumin <3 g/dl plus lymphocytes <1,000 cells/mm 3 (HR, 2.9; 95% CI, 1.8–4.6), presence of ascites (HR, 2.1; 95% CI, 1.06–4.2), age ≥50 (HR, 1.37; 95% CI, 1.02–1.8), and unresectable disease (HR, 2.6; 95% CI, 1.7–4.1) defined poor survival ( P = 0.00001). Conclusion Performing a multiorgan resection must be balanced between chances for long‐term survival and surviving a potentially fatal operation. Absence of metastases, serum albumin levels >3 g/dl, and accomplishment of R0 resection select patients with high probability of benefit from multiorgan resection. J. Surg. Oncol. 2008;98:336–342. © 2008 Wiley‐Liss, Inc.