Multivisceral resection vs standard gastrectomy for gastric adenocarcinoma

J Surg Oncol. 2020 Apr;121(5):840-847. doi: 10.1002/jso.25862. Epub 2020 Jan 31.

Abstract

Introduction: Multivisceral resection (MVR) is potentially curative for selected gastric cancer patients, supposedly at the cost of increased complications. However, current data comparing MVR to standard gastrectomy (SG) is lacking.

Objectives: Compare complications and survival after MVR and SG.

Methods: In a retrospective cohort of 1015 patients with gastric adenocarcinoma, 58 underwent MVR and 466 SG. Groups were compared concerning their characteristics, complications, and survival.

Results: One hundred seventy-six patients had postoperative complications. Major complications were more frequent after MVR (P = .002). Surgical mortality was 8.6% and 4.9% for MVR and SG (P = .221). Older age, higher morbidities, and MVR were independent risk factors for major complications. The odds ratio for major complications was 5.89 for MVR with one or two organs and 38.01 for MVR with three or more organs. The pancreas was the most commonly removed organ and pT4b disease were confirmed in 34 (58.6%) of the MVR cases. Disease-free survival (DFS) was lower in MVR patients (51% vs 77.8%; P < .001), being worse according to the number of organs resected. In pN+ patients, DFS was worse after MVR. DFS was equivalent to pT4b and non-pT4b in the MVR group.

Conclusions: Increased morbidity and lower survival are expected for gastric cancer patients undergoing MVR.

Keywords: gastric adenocarcinoma; gastric cancer; multiorgan; multivisceral resection.

MeSH terms

  • Adenocarcinoma / mortality
  • Adenocarcinoma / pathology
  • Adenocarcinoma / therapy
  • Age Factors
  • Chemotherapy, Adjuvant
  • Cohort Studies
  • Colon / surgery
  • Disease-Free Survival
  • Female
  • Gastrectomy*
  • Humans
  • Length of Stay / statistics & numerical data
  • Liver / surgery
  • Male
  • Middle Aged
  • Multimorbidity
  • Neoadjuvant Therapy
  • Pancreas / surgery
  • Postoperative Complications
  • Retrospective Studies
  • Risk Factors
  • Splenectomy
  • Stomach Neoplasms / mortality
  • Stomach Neoplasms / pathology
  • Stomach Neoplasms / therapy*