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World J Gastroenterol. Jun 7, 2008; 14(21): 3425-3429
Published online Jun 7, 2008. doi: 10.3748/wjg.14.3425
Pancreaticoduodenectomy for advanced gastric cancer with pancreaticoduodenal region involvement
Xin-Bao Wang, Li-Tao Yang, Ze-Wei Zhang, Jian-Min Guo, Xiang-Dong Cheng
Xin-Bao Wang, Li-Tao Yang, Ze-Wei Zhang, Jian-Min Guo, Xiang-Dong Cheng, Department of Hepato-Biliary-Pancreatico-Gastric Surgery, Zhejiang Cancer Hospital, Hangzhou 310022, Zhejiang Province, China
Author contributions: Wang XB performed the operation and wrote the paper; Yang LT analyzed the data; Zhang ZW followed up the patients; Guo JM and Cheng XD performed the operation.
Correspondence to: Xin-Bao Wang, Department of Hepato-Biliary-Pancreatico-Gastric Surgery, Zhejiang Cancer Hospital, Hangzhou 310022, Zhejiang Province, China. wangxinbao1964@sohu.com
Telephone: +86-571-88122012
Fax: +86-571-88122501
Received: December 21, 2007
Revised: April 7, 2008
Accepted: April 14, 2008
Published online: June 7, 2008
Abstract

AIM: To characterize the factors of the improved survival following combined pancreaticoduodenectomy (PD) and gastrectomy for the treatment of advanced gastric cancer with pancreaticoduodenal region involvement.

METHODS: From 1995 to 2004, 53 patients with primary gastric cancer were diagnosed with synchronous (n = 44) or metachronous (n = 9) pancreaticoduodenal region involvement. Of these, 17 patients (32%) underwent total gastrectomy (TG) or distal subtotal gastrectomy (SG) combined with PD simultaneously. The preoperative demographic, clinical information, clinicopathologic features and the surgical results of these 17 patients were considered as factors influencing survival and were analyzed by the Kaplan-Meier method with log-rank comparison.

RESULTS: The actual 1- and 3-year survival rates of these 17 patients after resection were 77% and 34%, respectively, and three patients survived for more than 5 years after surgery. The tumor-free resection margin (P = 0.0174) and a well-differentiated histologic type (P = 0.0011) were significant prognostic factors on univariate analysis. No mortality occurred within one mo after operation, postoperative weight loss of different degree was present in all the patients with TG and 12 cases had other complications. There were 9 (53%) cases of recurrence in 5-48 mo after operation. The survival rate in the palliative and explorative group was significantly (P = 0.0064) lower than in the combined PD group.

CONCLUSION: Judicious use of en bloc PD and gastrectomy and strictly preventing postoperative complications may improve the long-term survival for advanced gastric cancer patients with pancreati-coduodenal region involvement. Well-differentiated histology and negative resection margin are the most important predictors of long survival.

Keywords: Pancreaticoduodenectomy; Gastric cancer; Gastrectomy; Predictive factor; Patients