http://pubs.jamanetwork.com/ en-us Mon, 01 Apr 2013 00:00:00 GMT Wed, 17 Apr 2013 22:53:51 GMT Silverchair editor@pubs.jamanetwork.com webmaster@pubs.jamanetwork.com http://pubs.jamanetwork.com/article.aspx?articleID=1679629 Mon, 01 Apr 2013 00:00:00 GMT Hawkins WG. <span class="paragraphSection">Pacelli et al reported the Italian experience with multivisceral resection for locally advanced gastric cancer, and they concluded that “en bloc multivisceral resection should be the therapeutic choice.” In truth, the case for a more selective approach, such as the response to chemotherapy, is better supported by their data. The expertise of the authors and contributing surgeons is not in question. The surgical results of this selected experience are commendable. However, a critical review demonstrates that the most important contribution to the outcomes was careful patient selection, and the conclusion encouraging surgery in an unselective manner is potentially a disservice to most patients with locally advanced gastric cancer.</span> 148 4 361 361 10.1001/2013.jamasurg.331 http://pubs.jamanetwork.com/article.aspx?articleID=1679629 http://pubs.jamanetwork.com/article.aspx?articleID=1679642 Mon, 01 Apr 2013 00:00:00 GMT Pacelli F, Cusumano G, Rosa F, et al. <span class="paragraphSection"><div class="boxTitle">Importance</div>The role of multivisceral resection, in the setting of locally advanced gastric cancer, is still debated. Previous studies have reported a higher risk for perioperative morbidity and mortality, with limited objective benefit in terms of survival. Conversely, recent studies have shown the feasibility of enlarged resections and the potential advantage of extended resection for clinical stage T4b gastric adenocarcinoma with good long-term results.<div class="boxTitle">Objective</div>To analyze the role of multivisceral resection for locally advanced gastric cancer with particular attention to the brief and long-term results and to the prognostic value of clinical and pathologic factors.<div class="boxTitle">Design</div>Prospective multicenter study using data from between January 1, 1995, and December 31, 2008.<div class="boxTitle">Settings</div>Seven Italian surgery centers.<div class="boxTitle">Patients</div>A total of 2208 patients underwent curative resections for gastric carcinoma at the centers. Among them, 206 patients presented with a clinical T4b carcinoma. One hundred twelve underwent a combined resection of the adjacent organs with a gastrectomy owing to suspicion or direct invasion of these organs by the gastric cancer.<div class="boxTitle">Main Outcomes and Measures</div>Clinical and pathologic variables were prospectively collected and the feasibility and efficacy of multivisceral resection for locally advanced clinical T4b gastric cancer were assessed.<div class="boxTitle">Results</div>Postoperative mortality and complication rates of patients who underwent a gastrectomy with a combined resection of the involved organs were 3.6% and 33.9%, respectively. Pathologic factors revealed that the nodal involvement was present in about 89.3% of patients and the mean (SD) number of pathologic lymph nodes was 14.8 (16.6). The overall 5-year survival rate was 27.2%. The completeness of resection and lymph node invasion represent independent prognostic parameters at multivariate analysis.<div class="boxTitle">Conclusions and Relevance</div>Our study indicates that patients undergoing extended resections experience acceptable postoperative morbidity and mortality rates, and an en bloc multivisceral resection should be performed in patients when a complete resection can be realistically obtained and when lymph node metastasis is not evident.</span> 148 4 353 360 10.1001/2013.jamasurg.309 http://pubs.jamanetwork.com/article.aspx?articleID=1679642