Skip to main content
Log in

Extended surgery—Left upper abdominal exenteration plus Appleby's method—For type 4 gastric carcinoma

  • Original Article
  • Published:
Annals of Surgical Oncology Aims and scope Submit manuscript

Abstract

Background: The prognosis after surgical treatment for type 4 gastric cancer, including linitis plastica, remains poor. The most frequent recurrence mode is retroperitoneal involvement. To remove the tumor and microinvasion surrounding the stomach, extended surgery, left upper abdominal exenteration plus the Appleby's method (LUAE + Apl), has been performed for type 4 cancers since 1983.

Patients and Methods: A total of 54 patients with type 4 cancer underwent extended surgery (LUAE + Apl) over the past 11 years. In the LUAE + Apl surgical procedure, the whole stomach, pancreas body and tail, spleen, gallbladder, transverse colon, and left adrenal were removed en bloc. The results of this treatment are reported and the most beneficial application of this procedure (group A) is evaluated and compared with findings in similar patients who underwent common surgery between 1973 and 1983 (group B).

Results: As postoperative complications, pancreatic fistula (30%; control 19%), liver dysfunction (15%; 14%), anastomosis failure (6%; 9%), and infection (4%; 1%) were observed (NS). In group A, one patient died of liver dysfunction and another of multiple organ failure due to major pancreatic fistula. In stage III, the 5-year survival rate of group A (40%) was better than that of group B (20%; p<0.05). In stage IV, the 5-year survival rate of group A (5%; 3% in group B) was not improved.

Conclusion: LUAE + Apl improved the survival of patients with scirrhous cancer in stage III, but it was not effective for those in stage IV. To improve the survival of patients in stage IV, a new concept of treatment and supportive therapy needs to be used.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

  1. Arveux P, Faivre J, Boutron MC, et al. Prognosis of gastric carcinoma after curative surgery. A population-based study using multivariate crude and relative survival analysis.Dig Dis Sci 1992;37:757–63.

    Article  CAS  PubMed  Google Scholar 

  2. Balthhazar EJ, Rosenberg H, Davidian MM. Scirrhous carcinoma of the pyloric channel and distal antrum.Am J Roentgenol 1980;134:669–73.

    Google Scholar 

  3. Hirose S, Houjou H, Nakagawa H, et al. Carcinoma of the stomach: a clinicopathological study of 106 surgical cases.Gastroenterol Jpn 1989;24:481–7.

    CAS  PubMed  Google Scholar 

  4. Aranha GV, Georgen R. Gastric linitis plastica is not a surgical desease.Surgery 1989;106:758–63.

    CAS  PubMed  Google Scholar 

  5. Iwanaga T, Tanaka H, Furukawa H. Clinicopathological studies on spreading and recurrence of Borrman type 4 gastric carcinomas.Operation (Jpn) 1976;30:1301–5.

    Google Scholar 

  6. Sasiharan K, Legony A. Carcinoma of the stomach in a 24-year-old pregnant woman.Am J Gastroenterol 1989;84:990–1.

    Google Scholar 

  7. Kanter MA, Isaacson NH, Knoll SM, Nochomovitz LE. The diagnostic challenge of metastatic linitis plastica. Two cases and a consideration of the problem.Am Surg 1986;52:510–3.

    CAS  PubMed  Google Scholar 

  8. Fujimoto I, Hanai A, Oshima A, et al. Trends in incidence and mortality rates for selected primary sites in Osaka. In:Osaka Cancer Registry. Cancer incidence and mortality in Osaka. Tokyo: Shinohara Publishers, 1993:105–28.

    Google Scholar 

  9. Iwanaga T, Koyama H, Imaoka S, Furukawa H, Hiratsuka M. Scirrhous gastric cancer.J Clin Sci (Jpn) 1989;25:1192–7.

    Google Scholar 

  10. Japanese Research Society for Gastric Cancer.The general rules for the gastric cancer study. Tokyo: Kanehara Shuppan, 1993:20–27.

    Google Scholar 

  11. Ohashi I, Takagi K, Kajitani T. Left upper abdominal evisceration for advanced gastric carcinoma: indication and operative procedures.Gastroenterol Surg (Jpn) 1984;7:1535–42.

    Google Scholar 

  12. Appleby LH. The celiac axis in the expansion of the operation for gastric carcinoma.Cancer 1953;6:704–7.

    CAS  PubMed  Google Scholar 

  13. Tamura S, Okamoto T, Motohashi H, et al. Problem in the treated for Borrmann's type 4 gastric cancer.Jpn J Gastroenterol Surg 1987;20:34–9.

    Google Scholar 

  14. Iizuka I, Katayama K, Tanaka Y, et al. Postoperative complications of Appleby's operation—complications due to visceral ischemia and their prevention.Jpn J Gastroenterol Surg 1987;20:40–8.

    Google Scholar 

  15. Hiramatsu K.X-ray anatomy of the abdominal vascular system. Tokyo: Igaku-Shoin, 1982.

    Google Scholar 

  16. Hiatt JR, Gabbay J, Busuttil RW. Surgical anatomy of the hepatic arteries in 1000 eases.Ann Surg 1994;220:50–2.

    CAS  PubMed  Google Scholar 

  17. Konishi T, Mafune K, Hiraishi M, et al. Sequential methotrexate and 5-fluorouracil therapy for Borrmann type 4 gastric cancer.Gekashinryou (Jpn) 1990;32:581–6.

    Google Scholar 

  18. Nakajima T, Takahashi T, Takagi K, Kuno K, Kajitani T. Comparison of 5-fluorouracil with futrafur in adjuvant chemotherapies with combined inductive and maintenance therapies for gastric cancer.J Clin Oncol 1984;2:1366–71.

    CAS  PubMed  Google Scholar 

  19. Sautner T, Hofbauer F, Depisch D, Schiessel R, Jakesz R. Adjuvant intraperitoneal cisplatin chemotherapy does not improve long-term survival after surgery for advanced gastric cancer.J Clin Oncol 1994;12:970–4.

    CAS  PubMed  Google Scholar 

  20. Kelsen D, Brenann M. Neoadjuvant and post operative chemotherapy for high-risk gastric cancer. ASCO Proceedings, 1994.

Download references

Author information

Authors and Affiliations

Authors

Additional information

Presented at the 49th Annual Cancer Symposium of The Society of Surgical Oncology, Atlanta, Georgia, March 21–24, 1996.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Furukawa, H., Hiratsuka, M., Iwanaga, T. et al. Extended surgery—Left upper abdominal exenteration plus Appleby's method—For type 4 gastric carcinoma. Annals of Surgical Oncology 4, 209–214 (1997). https://doi.org/10.1007/BF02306612

Download citation

  • Received:

  • Accepted:

  • Issue Date:

  • DOI: https://doi.org/10.1007/BF02306612

Key Words

Navigation