Retrospective analysis of surgically treated pT4b gastric cancer with pancreatic head invasion

Table 1 Clinicopathological features of patients undergoing gastrectomy plus pancreatectomy and palliative gastrectomy alone

Variable	GP group, (n = 24) (%)	GA group, (n = 52) (%)	P value
Gender			0.486
Male	22 (91.7)	43 (82.7)
Female	2 (8.3)	9 (17.3)
Age (yr)			0.254
< 65	16 (66.7)	41 (78.8)
≥ 65	8 (33.3)	11 (21.2)
BMI (kg/m2)	23.5 ± 3.5	23.2 ± 3.3	0.779
ASA score			0.45
< 3	16 (66.7)	39 (75.0)
≥ 3	8 (33.3)	13 (25.0)
Neoadjuvant chemotherapy			< 0.001
Yes	10 (41.7)	44 (84.6)
No	14 (58.3)	8 (15.4)
Postoperative therapy			0.199
Chemotherapy	11 (45.8)	32 (61.5)
Chemoradiotherapy	13 (54.2)	20 (38.5)
Preoperative albumin (g/L)	37.9 ± 4.9	36.3 ± 5.1	0.083
Preoperative hemoglobin (g/L)	119.0 ± 28.2	108.3 ± 26.5	0.058
Linitis plastica			0.059
Yes	1 (4.2)	11 (21.2)
No	23 (95.8)	41 (78.8)
Borrmann type			0.312
I	1 (4.2)	1 (1.9)
II	8 (33.3)	18 (34.6)
III	14 (58.3)	23 (44.2)
IV	1 (4.2)	10 (19.2)
Tumor size (cm)	9.3 ± 2.3	6.7 ± 1.9	< 0.001
Histological type			0.945
Poorly differentiated	20 (83.3)	43 (82.7)
Well–moderately differentiated	4 (16.7)	9 (17.3)
Pathological N stage			0.03
N0	0 (0.0)	0 (0.0)
N1	0 (0.0)	0 (0.0)
N2	5 (20.8)	17 (32.7)
N3a	5 (20.8)	16 (30.8)
N3b	14 (58.3)	19 (36.5)
Lymphovascular invasion			0.168
Yes	22 (91.7)	41 (78.8)
No	2 (8.3)	11 (21.2)
Neural invasion			0.638
Yes	17 (70.8)	34 (65.4)
No	7 (29.2)	18 (34.6)
Surgical margin			< 0.001
R0	21 (87.5)	0 (0.0)
R1	3 (12.5)	52 (88.5)

Values are percentages or mean ± SD. GA: Gastrectomy alone; GP: Gastrectomy plus pancreatectomy; BMI: Body mass index; ASA: American Society of Anesthesiologists.

Table 2 Surgical outcome of patients undergoing gastrectomy plus pancreatectomy and gastrectomy alone

Variable	GP group, (n = 24) (%)	GA group, (n = 52) (%)	P value
Intraoperative blood loss (mL)	443.8 ± 104.6	144.2 ± 64.7	< 0.001
Operation time (min)	223.3 ± 41.6	192.9 ± 29.6	0.003
Postoperative hospital stay (d)	18.2 ± 5.9	10 ± 3.6	< 0.001
Postoperative mortality	1 (4.2)	2 (3.8)	1
Postoperative morbidity	8 (33.3)	8 (15.3)	0.128
Local complications	5 (20.8)	6 (11.5)	0.324
Abdominal infection	1	0
Anastomotic fistula	0	1
Abdominal hemorrhage	1	0
Gastrointestinal hemorrhage	0	1
Disruption of wound	1	0
Pancreatic fistula	2	3
Duodenal stump fistula	0	1
Systemic complications	3 (12.5)	2 (3.8)	0.177
Pulmonary infection	1	0
Pneumothorax	1	1
Renal failure	0	0
Diabetic ketoacidosis	1	0
Cardio- and cerebrovascular event	0	1
Clavien–Dindo classification			0.309
II	1	3
IIIa	2	1
IIIb	3	1
IVa	1	0
IVb	0	1
V	1	2

GA: Gastrectomy alone; GP: Gastrectomy plus pancreatectomy.

Table 3 Univariate and multivariate analysis of prognostic factors for pT4 gastric cancer with pancreatic head invasion

Variable	Univariate analysis		Multivariate analysis
					HR (95%CI)
	P value	HR (95%CI)	P value
Age ≥ 65/< 65 yr	1.19 (0.567–2.505)	0.644	—	—
Gender (male/female)	1.01 (0.369–2.101)	0.346	—	—
Preoperative hemoglobin < 35 g/L (yes/no)	1.09 (0.423–3.205)	0.524	—	—
Preoperative anemia	1.18 (0.523–2.985)	0.502	—	—
(hemoglobin < 90 g/L) (yes/no)
Neoadjuvant chemotherapy (yes/no)	0.180 (0.073–0.446)	< 0.001	0.29 (00.103–0.821)	0.02
Operation type (GP/GA)	0.393 (0.188–0.819)	0.013	0.689 (0.157–3.019)	0.621
Borrmann type		0.159	—	—
I	1
II	1.399 (0.266–7.358)	0.692
III	0.479 (0.164–1.403)	0.179
IV	0.398 (0.144–1.100)	0.076
Tumor diameter > 7/≤ 7 cm	0.380 (0.190–0.758)	0.006	—	—
Tumor type (linitis plastica/not)	2.764 (1.127–6778)	0.026	2.614 (1.024–6.675)	0.033
Intraoperative blood loss > 400mL (yes/no)	1.089 (0.347–2.102)	0.154
Operation time > 240 min	1.021 (0.233–3.112)	0.423
Surgical margin (R0/R1)	2.501 (1.177–5.314)	0.017	0.274 (0.102–0.738)	0.01
Lymphovascular invasion (yes/no)	2.512 (1.066–5.921)	0.035	1.517 (0.930–2.476)	0.095
Perineural invasion (yes/no)	1.545 (0.781–3.054)	0.211	—	—
Differentiation type (poor/well–moderate)	1.358 (0.610–3.021)	0.454	—	—
N stage(N0/N1/N2/N3a/N3b)	1.708 (1.103–2.644)	0.016	3.489 (1.334–9.120)	0.011
Postoperative treatment (chemotherapy/chemoradiotherapy)	0.347 (0.159–0.757)	0.008	0.369 (0.163–0.836)	0.017

HR: Hazard ratio; CI: Confidence interval; GP: Gastrectomy combined with pancreatectomy; GA: Gastrectomy alone.