Our Summary

This study looks at the experiences of a single surgeon who performed extended gastrectomy, which is a type of surgery where parts of the stomach and sometimes other nearby organs are removed, on patients with advanced gastric adenocarcinoma, a type of stomach cancer. The study covers operations performed from May 2004 to December 2017.

The research found that 587 gastrectomies were performed in total, with 87 of them being classified as extended resections. These extended surgeries often included removing parts of the pancreas, spleen, colon, and liver. These more complex surgeries resulted in similar post-surgery outcomes and survival rates when compared to standard gastrectomy.

However, extended gastrectomy was associated with larger tumor sizes, more blood loss, and the need for total gastrectomy (removal of the entire stomach) more often than the standard procedure. Despite these challenges, as the surgeon gained more experience, they were able to consider more complex surgeries and extensive lymph node removal.

The median survival time after extended gastrectomy for advanced gastric adenocarcinoma was 14 months and the three-year survival rate was 18% - similar to the outcomes for standard gastrectomy for less advanced cancers.

The study also found that obesity, the stage of the cancer in the lymph nodes, and the type of gastrectomy performed had an impact on survival rates for patients with advanced gastric adenocarcinoma. In particular, obesity and advanced stages of lymph node involvement were found to be independent predictors of survival.

The study concludes that extended gastrectomy can provide satisfactory surgical outcomes for patients with advanced gastric adenocarcinoma, even when more complex surgeries are required. However, given the poor prognosis of this type of cancer, the researchers suggest considering pre-surgery therapy to improve long-term survival rates.

FAQs

  1. What is the purpose of the study on extended gastrectomy for T4b stage gastric adenocarcinoma?
  2. What were the outcomes of the study on extended gastrectomy for T4b gastric adenocarcinoma?
  3. What factors were found to be associated with survival in T4b adenocarcinoma?

Doctor’s Tip

A helpful tip a doctor might tell a patient about gastrectomy is to follow a healthy and balanced diet post-surgery to aid in the healing process and prevent complications. This may include eating smaller, more frequent meals and avoiding foods that may irritate the stomach. Additionally, staying hydrated and taking any prescribed medications as directed can also help in the recovery process.

Suitable For

Patients who are typically recommended for gastrectomy include those with T4b stage gastric adenocarcinoma, which involves invasion of adjacent organs or structures. These patients may have larger tumor sizes, require total gastrectomy, and have increased blood loss during surgery. Extended gastrectomy may be considered for these patients, with en-bloc resection of adjacent organs such as the pancreas, spleen, colon, and liver.

Patient selection criteria for extended gastrectomy may be expanded over time as surgeons gain more experience with the procedure. However, neoadjuvant therapy should be considered for these patients to improve long-term oncologic outcomes. Factors such as obesity, nodal stage, and type of gastrectomy may also impact survival in patients undergoing gastrectomy for T4b gastric adenocarcinoma.

Timeline

Before gastrectomy:

  1. Patient is diagnosed with T4b stage gastric adenocarcinoma.
  2. Patient undergoes various tests and imaging studies to determine the extent of the cancer.
  3. Patient may undergo neoadjuvant therapy to shrink the tumor before surgery.
  4. Patient is evaluated for surgical eligibility and risks.

After gastrectomy:

  1. Patient undergoes extended gastrectomy, including en-bloc resection of adjacent organs if necessary.
  2. Patient may experience larger tumor size, increased blood loss, and longer recovery time compared to standard gastrectomy.
  3. Patient may have expanded patient selection criteria and considered for complex resections and extensive lymphadenectomy.
  4. Median and 3-year survival following extended gastrectomy for T4b adenocarcinoma are reported as 14 months and 18%, respectively.
  5. Factors such as obesity, nodal stage, and type of gastrectomy are associated with survival in T4b adenocarcinoma.
  6. Neoadjuvant therapy is recommended to improve long-term oncologic results.

What to Ask Your Doctor

  1. What are the potential risks and complications associated with extended gastrectomy, including en-bloc resection of adjacent organs/structures?

  2. How will my quality of life be impacted after undergoing extended gastrectomy?

  3. What are the long-term survival rates for patients who undergo extended gastrectomy for T4b stage gastric adenocarcinoma?

  4. What are the criteria for determining if I am a suitable candidate for extended gastrectomy?

  5. What is the recovery process like after extended gastrectomy, and what can I expect in terms of postoperative care and follow-up appointments?

  6. Will I need to undergo any additional treatments, such as chemotherapy or radiation therapy, after extended gastrectomy?

  7. How experienced is the surgical team in performing extended gastrectomy procedures, and what is their success rate with this type of surgery?

  8. Are there alternative treatment options available for T4b stage gastric adenocarcinoma that I should consider before deciding on extended gastrectomy?

  9. How will extended gastrectomy impact my ability to eat and digest food, and what dietary changes may be necessary post-surgery?

  10. What support services are available to help me cope with the emotional and psychological aspects of undergoing extended gastrectomy for T4b stage gastric adenocarcinoma?

Reference

Authors: Sahakyan MА, Gabrielyan A, Petrosyan H, Yesayan S, Shahbazyan SS, Sahakyan AM. Journal: J Gastrointest Cancer. 2020 Mar;51(1):135-143. doi: 10.1007/s12029-019-00222-z. PMID: 30895429