Cancer surgery is complete resection of primary tumor along with the areas of lymphatic spread. Although in the majority of patients with gastric carcinoma the primary lesion is confined to the gastric wall, in about 10 to 20 percent of resected
patients, the tumor crosses the serosal layer and extends to adjacent organs.
In such cases, others have suggested the need for extensive en bloc resection of the invaded organs. But still remained may problems as considerable morbidity and mortality. Authors reviewed 305 cases of gastric carcinoma who had multiple organ
resection in Gospel Hospital during 10 years from January 1980 through December 1989.
@ES The results were as follows;
@EN 1) The range of the age was from 23 to 80 years of age. The peak age group was in the 6th decade940.7%),and the ratio of male to female was 1.7:1.
2) Material were as follows; In curative resection group, total gastrectomy was 94 cases(30.8%), subtotal gastrectomy was 72 cases(23.6%) and in palliative group, total gastrectomy was 88 cases(28.9%), subtotal gastrectomy was 51 cases(16.7%).
3) The primary sites of the gastric carcinoma were the body(56.1%), the antrum(23.9%), the cardia and/or fundus(15.4%), and the diffuse involvement(4.6%), respectively.
4) In TNM stage(AJCC, 1988), stage III(46.9%) and IV(35.1%) were common. Stage I was 7.5% and stage II was 14.1%.
5) The most common resected organs in multiple organ resection were spleen and pancreas (70.5%). The others were colon and/or mesocolon(14.8%), liver(4.7%), gall bladder(2.9%), ovary(2.0%), esophagus(1.8), adrenal gland(1.7%),duodenum and
jejunum(0.7%)m common bile duct (0.7%), and kidney(0.2%).
6) Of the 305 patients who underwent multiple organ resection, resection of 2 organs(45.2%) was most common, then followed by 1 organ(38.4%), 3 organs(14.1%), 4 organs(0.9%), 5 organs(0.7), and 6 organs(0.7%).
7) The postoperative complication rate was 25.6%: Leakage was the most common complication Others were pulmonary complication, intraabdominal abscess, wound infection, intestinal obstruction and gastrointestinal bleeding.
The complication rate was increased in proportion to number of combined organ resection.
8) The overall operative mortality rate was 2.0%; The cause of death was anastomosis leakage(0.7%), gastrointestinal bleeding(0.7%), myocaridiac infarction(0.3%) and acute renal failure (0.3%).
The operative mortality was associated with combined resection of spleen or pancreas.
9) The overall 5-year survival rate was 19.7%.
10) In curative resection group, the 5-year survival rate of stage I was 65.4%, of stage II 55.2%, of stage III 16.9% and of stage IV 0%, respectively.
The overall 5-year survival rate was 27.5% in curative resection group.
11) Nodal status is more valuable than primary tumor status as a prognostic factor(p<0.05).
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