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2001 Abstract: 2484 Achieving R0 resection for locally advanced gastric cancer: Is it worth the risk with multi-organ resection?

2001 Digestive Disease Week

# 2484 Achieving R0 resection for locally advanced gastric cancer: Is it worth the risk with multi-organ resection?
Robert C.G. Martin II, Murray F. Brennan, David P. Jaques, Dennis Leung, Martin Karpeh, New York, NY

Introduction: In gastric adenocarcinoma, only complete resection (RO) translates into survival benefit. Given the potential for increased morbidity and mortality from multiple organ resection we asked the question as to whether extended (multiple organ) resection was justified for advanced gastric cancer.

METHODS: From 7/85 to 7/2000, 2112 patients underwent gastric resection for adenocarcinoma, and were entered and followed in a prospectively recorded database. Four hundred and eighteen patients undergoing primary resection had one or more organs resected in addition to the stomach. Clinicopathologic, operative, and survival data was compared between these groups. Complications were categorized by severity on a scale from 0 to 5; 0 no complication, 1 oral antibiotics, 2 intravenous antibiotics or TPN, 3 operative or interventional radiology drainage, 4 enteral diversion, and 5 death. Chi square analysis as well as Logistic Regression method was used to compare and estimate factors significant for complications.

RESULTS: Three hundred and thirty-seven patients with a single additional organ resected, 63 two organs, and 18 with three organs. Logistic regression identified only the number of organs resected, two or greater, to be predictive of complications (RR 2.0). When excluding minor complications (values 1 and 2), again number of organs resected (RR 3.8) was a significant factor of severe complications (values 3, 4, and 5).

CONCLUSIONS: Resection of 2 or greater adjacent organs in advanced gastric adenocarcinoma increases complications, but is associated with an equivalent median survival (16.9 mon) when compared to patients with one organ resected (16.5 mon).

Organ N Morbidity LOS Survival

(1&2) (3&4) 5 p (median) (median)

Spleen only 166 23% 12% 4% ns 15 days 21.9 mon

Colon only 33 18% 12% 6% ns 14 days 13.4 mon

Liver only 28 28% 4% 4% ns 14 days 11.5 mon

2 organs 63 29% 16% 2% 0.04 20 days 16.9 mon

3 oragns 18 28% 39% 6% 0.01 23 days 17.9 mon

All Patients 418 23% 13% 4% 15 days 16.6 mon

Society for Surgery of the Alimentary Tract

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