Comparision Pathohistologic T3 with T4 in Clinical T4 Gastric Cancer which was Treated with Radical Gastrectomy Combined Colon Segmental Resection

ABSTRACT

PURPOSE: If a mesocolon or colon invasion of gastric cancer was clinically suspected during an operation, a colon resection combined with a gastrectomy is generally recommended. However, sometimes no pathologic invasion of cancer cells is experienced. Therefore, the aim of this study was to compare post operative pathohistologic T3 and T4 in cases of clinical proven T4 when treated by a radical gastrectomy combined a colon segmental resection. METHODS: Thirty-eight patients were treated by a radical gastrectomy (D2 lymph node dissection) combined with a colon segmental resection at the Department of Surgery, Gospel Hospital, Kosin University, between Jan. 1990 and Dec. 2001. The accuracy of the preoperative clinical T-stage was analyzed, along with a retrospective analysis of age, gender, tumor site and size, type of gastrectomy, histology, lymph node metastasis, Borrmann type, tumor marker (CEA), and the rates of complications, mortality and survival between pathohistologic T3 and T4. The survival rate was analyzed by the Kaplan-Meier method using the SPSS statistical program; other statistical analyses were performed using the chi-squared test. RESULTS: Stomach cancer, suspected of mesocolon mesentery or colon invasion in the operation field, was treated with an extended radical gastrectomy with colon segmental resection (122 cases). Of the 122 cases 84, which had incurable factors, such as peritoneal metastasis, liver metastasis and follow up loss, were excluded. The remaining 38 cases were curatively treated with an extended radical gastrectomy combined colon segmental resection and D2 lymph node dissection. The accuracy of the clinical T-stage from preoperative CT scans were clinical and pathological T4 in 23 (60.5%) and 17 (44.8%) of the 38 cases, respectively. The 5 year survival rates of pathohistologic T3 and T4 were 21.2 and 13.5%, respectively. CONCLUSION: There was no significant difference between the pathohistologic T3 or T4 stages with respect to the survival rate and other clinical features. For these reasons, a radical gastrectomy combined a colon segmental resection is suggested with stomach cancer when mesocolon mesentery or colon invasion is suspected.