OBJECTIVE
To study the immediate and long-term results of multivisceral surgeries with pancreaticoduodenectomy for gastric cancer.
MATERIAL AND METHODS
The 1st group included 24 patients who underwent multivisceral surgeries with pancreaticoduodenectomy for gastric cancer with pancreatic head and/or duodenum invasion. The 2nd group included 60 patients with gastric cancer who underwent partial resection of the pancreatic head and/or duodenum rather pancreaticoduodenectomy.
RESULTS
ASA class III was observed in 10 (41.7%) out of 24 patients in the 1st group and in 12 (20.0%) out of 60 patients in the 2nd group (p=0.041). In group 2, there were no cases of vein invasion (0 versus 12.5%; p=0.021). In group 1, Clavien-Dindo grade ≥3 complications were more common (10 (41.7%) vs. 14 (23.3%) cases, p=0.005). Moreover, pancreatic fistulas of all classes were more common (9 (37.5%) vs. 9 (15.0%) cases, p=0.023). Median overall survival was 15 and 14 months, respectively. Overall five-year survival was 24.1% (95% CI 7.8—45.2) and 8.2% (95% CI 2.3—18.9%), respectively (p=0.483). Locoregional recurrence was more common in the 2nd group (23 (41.8%) out of 55 vs. 3 (13.6%) out of 23 patients, p=0.018). In the 1st group, median overall survival without adjuvant chemotherapy was 13 months (95% CI 5—17), in the group with adjuvant chemotherapy — 37 months (95% CI 14—64). Overall five-year survival was 7.7% (95% CI 5—29.2) and 50.0% (95% CI 13.7—78.5), respectively (p=0.003). Median overall survival in the 2nd group without adjuvant chemotherapy was 13 months (95% CI 5—17), in the 2nd group with chemotherapy — 17 months (95% CI 12—29; p=0.016). The risk of death in the 2nd group with chemotherapy was lower than in the 1st group without chemotherapy (OR 0.385; 95% CI 0.183—0.809; p=0.012). Multivariate analysis in the 1st group revealed that ASA class 3 negatively affected overall survival (OR 3.04; 95% CI 1.04—8.81; p=0.040). Multivariate analysis after combining both groups established that negative factors of long-term prognosis were female gender (OR 2.47; 95% CI 1.25—4.87; p=0.009), coronary artery disease (OR 3.44; 95% CI 1.16—10.17; p=0.025), locoregional recurrence (OR 2.49; 95% CI 1.13—5.50; p=0.024) and type B pancreatic fistula (OR 2.68; 95% CI 1.070—6.731; p=0.035). Positive factors were multivisceral surgeries with pancreaticoduodenectomy (OR 0.36; 95% CI 0.14—0.86; p=0.023) and adjuvant chemotherapy (OR 0.27; 95% CI 0.13—0.57; p<0.001).
CONCLUSION
Multivisceral surgeries with pancreaticoduodenectomy for gastric cancer with pancreatic and/or duodenal invasion is justified in patients with ASA class 1—2 due to higher probability of adjuvant chemotherapy and better survival.
