Combined Resection of Invaded Organ in Patients with T4 Gastric Cancer

PURPOSE: Combined resection of invaded organ in advanced gastric cancer has been performed for complete removal of tumor and clearance of regional lymph node. However, higher morbidity and mortality associated with this procedure have been reported in recent large series and the efficacy of the procedure in survival remains controversial. In this study, we analyzed the efficacy of gastrectomy combined with invaded organ resection. METHODS: The medical records of 153 patients with T4 gastric carcinoma who underwent operation at Department of Surgery, Kangnam St. Mary's Hospital, The Catholic University of Korea from 1990 to 1998 were evaluated retrospectively. The patients were divided into three groups. Thirty five patients with combined resection were included in group I, and 72 patients with gastrectomy alone were in group II and 46 patients with no resection were included in group III. RESULTS: Pancreas was the most frequently invaded organ (100 patients: 65.4%), followed by colon (57 patients: 37.3%). The patients of group III were older than that of group I, and the tumor size was bigger in group I than group II. Incidence of the lower one third of the gastric cancer was higher in group II and III than that of group I. Histologically, undifferentiated carcinomas were more frequent in all groups. Postoperative complications in group I occurred in 11 patients (31.5%): intraabdominal abscess (4 patients: 11.4%), duodenal stump leakage (2 patients: 5.7%), renal failure (2 patients: 5.7%), and followed by bleeding, pulmonary complication, pancreatitis. Operative mortality of group I was 2.9%. The 5-year survival rate of group I and II was 15.6% and 3.1%, respectively and 0% in group III. In patients without peritoneal or liver metastasis, the 5-year survival rate of group I and II was 27.0% and 5.5%, respectively. But in patients with incurable factors, there was no difference in survival between the two groups. Median survival of group I with incurable factors was only 7 months. CONCLUSION: Combined resection of invaded organ in patients with T4 gastric carcinoma is a relatively safe procedure. Combined resection should be considered in patients without incurable factors such as peritoneal or liver metastasis.

A Case of Neurofibroma Causing Duodenal Obstruction

Neurofibroma is a benign tumor characterized by diffuse proliferation of the peripheral nerve elements. It mostly occurrs in the retroperitoneal region. Although neurofibroma may occurr as a solitary lesion, its common manifestation is in the syndrome of neurofibromatosis with a variable clinical course. Neurofibroma is a slowly growing neoplasm that presents symptoms only after a period of several years. Complete surgical removal is the treatment of choice, however this can be occasionally dangerous because of their tendency to adhere to adjacent structures. Herein we report a case of neurofibroma causing duodenal obstruction.