Site Overlay

Anatomical resections of the pancreas in locally advanced stomach cancer

Volume 10, Issue 1

Original Article / Published: July 2022



Clinic of Liver-Bile, Pancreatic and General Surgery; Acibadem City Clinic Tokuda Hospital Sofia EAD, Sofia


Introduction and objective: Gastric cancer is one of the most common cancers and a cause of death globally. Frequent infiltration of the tumor into neighbouring organs (pancreas and/or duodenum) requires curative, multivisceral resections. Achieving clean resection lines is essential for the prognosis in patients with locally advanced disease. The objective of this study is to analyze the perioperative results in a group of 18 patients with different anatomical resections of the pancreas in the course of multivisceral resections in an attempt to achieve surgical radicalism.

Material and methods: Patients in the study group were assessed for perioperative morbidity, mortality, and survival and stratified according to the need and type of multivisceral resection. Cases of partial resections of the gland are excluded from the study. Statistical methods were used to analyze the perioperative results

Results: In the study group, the male / female ratio was 77.8% to 22.2%. The average age is 63.1 years. The average hospital stay is 10.5 days. Perioperative mortality is 5.5% (1 case). Complications were observed in 7 cases (38.8%). Pancreatic leakage was registered in 4 cases (22.2%).

Conclusion: Multivisceral resection is associated with higher perioperative morbidity and slightly higher perioperative mortality. Patients who are expected to undergo this type of surgical treatment should be selected with extreme caution, as long-term survival remains poor.



  1. Jemal A, Bray F, Center MM, Ferlay J, Ward E, Forman D. Global cancer statistics. CA Cancer J Clin. 2011;61:69–90.
  2. Ferlay J, Shin HR, Bray F, Forman D, Mathers C, Parkin DM. Estimates of worldwide burden of cancer in 2008: GLOBOCAN 2008. Int J Cancer. 2010;127:2893–917.
  3. Desai AM, Pareek M, Nightingale PG, Fielding JW. Improving outcomes in gastric cancer over 20 years. Gastric Cancer. 2004;7:196–201; discussion 201–3.
  4. Maruyama K, Okabayashi K, Kinoshita T. Progress in gastric cancer surgery in Japan and its limits of radicality. World J Surg. 1987;11:418–25.
  5. Cuschieri A, Fayers P, Fielding J, et al. Postoperative morbidity and mortality after D1 and D2 resections for gastric cancer: preliminary results of the MRC randomised controlled surgical trial. The Surgical Cooperative Group. Lancet. 1996;347:995–9.
  6. Cuschieri A, Fayers P, Fielding J, et al. Postoperative morbidity and mortality after D1 and D2 resections for gastric cancer: preliminary results of the MRC randomised controlled surgical trial. The Surgical Cooperative Group. Lancet. 1996;347:995–9.
  7. Brar SS, Seevaratnam R, Cardoso R, et al. Multivisceral resection for gastric cancer: a systematic review. Gastric Cancer. 2012;15(Suppl 1):S100–7.
  8. Lo SS, Wu CW, Shen KH, Hsieh MC, Lui WY. Higher morbidity and mortality after combined total gastrectomy and pancreati- cosplenectomy for gastric cancer. World J Surg. 2002;26:678–82.
  9. Маринов В, Радойчич М. Аспекти на хирургичното лечение на рака на стомаха. Хириургични заболявания МП, 36, 2005,N3, 17-22. ISSN – 1312 – 0344
  10. Power DG, Schattner MA, Gerdes H, Brenner B, Markowitz AJ, Capanu M, Coit DG, Brennan M, Kelsen DP, Shah MA. Endoscopic Ultrasound Can Improve the Selection for Laparoscopy in Patients with Localized Gastric Cancer. Journal of the American College of Surgeons. 2009;208(2):173-8
  11. Martin RC, 2nd, Jaques DP, Brennan MF, Karpeh M. Extended local resection for advanced gastric cancer: increased survival versus increased morbidity. Annals of Surgery. 2002;236(2):159-65.
  12. Carboni F, Lepiane P, Santoro R, Lorusso R, Mancini P, Sperduti I, Carlini M, Santoro E. Extended multiorgan resection for T4 gastric carcinoma: 25-year experience. Journal of surgical oncology. 2005;90(2):95-100.
  13. Pacelli F, Cusumano G, Rosa F, Marrelli D, Dicosmo M, Cipollari C, Marchet A, Scaringi S, Rausei S, di Leo A, Roviello F, de Manzoni G, Nitti D, Tonelli F, Doglietto GB, Italian Research Group for Gastric Cancer ft. Multivisceral Resection for Locally Advanced Gastric Cancer: An Italian Multicenter Observational Study. JAMA Surgery. 2013;148(4):353-60.
  14. Marinov V. Potentially curative multivisceral resections for locally advanced colorectal cancer. Scripta Scientifica Medica, vol. 48, No. 2, 2016, 27-31. ISSN – 0582 – 3250
  15. Marinov V, Gaidarski R, Draganov K, Katev N.N, Rusenov D; Kolev Y, Petreska A, Borisov B, Changalova G, Lavchev S, Penchev D, Stoyanova D, Tonev S. Locally advanced adenocarcinoma of the supramesocolic part of the colon. Features of surgical treatment and challenges. Scripta Scientifica Medica, vol. 45, Suppl. 2, 2013, pp. 79-85 ISSN – 0582 – 3250
  16. Aversa J, Diggs L, Hagerty B, Dominguies D, Lituarte P et al. Multivisceral Resection for Locally Advanced Gastric Cancer. J Gastroinest Surg. 2021 Mar;25(3):609-622
  17. Маринов В, Драганов К, Гайдарски Р, Русенов Д. Мултивисцерални резекции при локално авансирал рак на стомаха. Възможности и хирургични предизвикателства. XVI- ти Национален Конгрес по Хирургия. Електронен сборник с доклади 2018.
  18. Darren R Cullinan, Stephen W Behrman. Multi-visceral resection of locally advanced extra-pancreatic carcinoma. Hepatobilliary Pancreat Dis Int. 2014 Apr;13(2):198-202.
  19. Драганов К, Маринов В, Колев Я, Петреска А, Борисов Б, Тонев С, Гайдарски Р.Хирургия на панкреаса – резултати, прогностични фактори, профилактика на ранните постоперативни усложнения. XIII Национален конгрес по хирургия 2010. Кн I, 79-81 ISSN: 1314-2097
Click to review Volume 10, Issue 1


Multivisceral resection, advanced gastric cancer, pancreas

How to cite this article:

El-Tal L. Anatomical resections of the pancreas in locally advanced stomach cancer. Journal of Endourology and Minimally Invasive Surgery (Bulgaria), 2022; 10(1):43-46

Corresponding author:

Dr. Luben El-Tal

Clinic of liver and pancreatic and  general surgery

Acibadem City Clinic Tokuda Hospital, Sofia

Address: Bul. ”N. Vaptsarov” 51B, Sofia, Bulgaria

E-mail: luben.eltal @