Outcomes after gastrectomy plus pancreatic resection for gastric cancer invading the pancreas

BACKGROUND: Radical resection is the primary treatment for resectable gastric cancer (GC). However, outcomes remain poor for patients requiring combined gastrectomy and pancreatic resection due to pancreatic invasion. This study compares surgical and survival outcomes between radical (R0) gastrectomy with pancreaticoduodenectomy (PD) versus distal pancreatectomy (DP). METHODS: We retrospectively analyzed 81 patients with pancreatic-invading GC who underwent R0 gastrectomy with pancreatic resection (January 1994-June 2023). Demographics, surgical complications, adjuvant chemotherapy, and survival outcomes were assessed (median follow-up: 13.4 months). RESULTS: Among the cohort, 36 patients underwent gastrectomy with PD, and 45 underwent gastrectomy with DP. The DP group had significantly more total gastrectomies (88.9% vs. 36.1%, p < 0.0001), tumors localized to the upper stomach (p < 0.0001), and a higher metastatic-to-total lymph node ratio (0.30 vs. 0.15, p = 0.024). Postoperative pancreatic fistula occurred less frequently in the DP group (17.8% vs. 61.1%, p < 0.0001), correlating with a shorter median hospital stay (17 vs. 22 days, p = 0.045). Patient age, tumor characteristics, mortality, lymph node retrieval, and adjuvant chemotherapy use were comparable. Two-year disease-free survival (14.5% PD vs. 20.9% DP, p = 0.988) and cancer-specific survival rates (26.8% PD vs. 32.1% DP, p = 0.815) showed no differences. Multivariate analysis identified stage IIIC (reference: IIIA) as an independent prognostic factor for both disease-free survival (adjusted hazard ratio 3.91, p = 0.015) and cancer-specific survival (adjusted hazard ratio 3.12, p = 0.045). CONCLUSIONS: Gastrectomy with PD or DP yields similarly poor outcomes for pancreatic-invading GC. Tumor stage (nodal status) is the dominant prognostic factor.