Long term survival after total gastrectomy and pancreatoesplenectomy for T4B gastric cancer invading the pancreas in a High-volume Latin American Center

Objective: To evaluate postoperative morbidity and mortality up to 90 days and long-term survival in patients with locally advanced gastric cancer (GC) who underwent total gastrectomy with pancreatosplenectomy (TGPS) Summary Background Data: Resection without residual tumor (R0) is the only curative treatment for gastric cancer (GC). TGPS improves the survival of patients with GC with clinical pancreatic invasion (cT4b), however increased postoperative morbidity and mortality. Methods: We enrolled patients with GC who underwent elective TGPS for cT4b between 1996 and 2023. We determined the extent of tumor invasion into the pancreas intraoperatively, and the final pathological stage using delayed biopsy. We used the Clavien–Dindo classification and eighth edition of the TNM staging system and used the Kaplan–Meier survival curves with a log-rank test, descriptive statistics, and univariate and multivariate analyses. Results: Ninety-two patients underwent TGPS for cT4b disease. The morbidity incidence with a Clavien grade ≥3 was 32%. Overall, the mortality rates at 30, 60, and 90 days were 8.7%, 16.3%, and 21,7%, respectively. The rate at 90 days, in the last seven-years, was 7.7%. The 5-year survival rates of patients who underwent curative intent surgery with cT4b, with and without definitive pancreatic invasion were 16.7% and 51.4%, respectively (p =0.0235). Conclusions: TGPS with curative intent in patients with cT4b GC on the pancreas resulted in a long-term survival rate of up to 51.4%. Patients showed decreased postoperative mortality over time. These results support en bloc resection of cT4b on the pancreas.