Predictors of operative morbidity and mortality in gastric cancer surgery
ABSTRACT The aim of this study was to identify factors that predict morbidity and mortality in gastric cancer surgery.
Data on 719 consecutive patients who underwent operations for gastric cancer at Seoul National University Hospital between January and December 2002 were reviewed.
Overall morbidity and mortality rates were 17.4 per cent (125 patients) and 0.6 per cent (four patients) respectively, and the rates of surgical and non-surgical complications were 14.7 per cent (106 patients) and 3.3 per cent (24 patients). Morbidity rates were higher in patients aged over 50 years (odds ratio (OR) 1.04 (95 per cent confidence interval (c.i.) 1.02 to 1.06)), when the gastric tumour was resected with another organ (36 per cent for combined resection versus 15.4 per cent for gastrectomy only; OR 3.25 (95 per cent c.i. 1.76 to 6.03)) and when gastrojejunostomy was used for reconstruction after subtotal gastrectomy (17.0 per cent for Billroth II versus 9.5 per cent for Billroth I; OR 2.00 (95 per cent c.i. 1.05 to 3.79)). Only three patients (2.8 per cent) with a surgical complication underwent reoperation, two for adhesive obstruction and one for intra-abdominal bleeding.
Age, combined resection and Billroth II reconstruction after radical subtotal gastrectomy were independently associated with the development of complications after gastric cancer surgery.
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ABSTRACT: The aim of this study was to evaluate the outcome for gastric cancer patients treated at a medium sized Norwegian hospital. The medical journals of all 356 patients with gastric cancer treated at Levanger Hospital from 1980 to 2004 were retrospectively analysed. Follow-up with regard to survival was complete. The Department of Surgery had treated 277 patients (78%). The resection rate of patients admitted to the Department of Surgery was 56% (154/277), and the total resection rate was 43% (154/356). R0 resection was done in 97 patients (27%), R1 resection in 16 (4%), palliative R2 resection in 41 (12%), other palliative procedures in 59 (17%), and only palliative care was given for 143 (40%) patients. The 30-days postoperative mortality was 2.7% (3/113) after R0 and R1 resections, 4.9% (2/41) after R2 resections, and 24% (14/59) after other palliative procedures. After R0 resections, the estimated overall 5-year survival was 39% (95% C.I. 29-49). After R1 and R2 resections, none survived 5 years and the estimated overall 2-year survival was 12% (95% C.I. 0-27%) and 2% (95% C.I. 0-7%), respectively. Estimated overall 5-year survival was closely related to stage: 91% (95% C.I. 74-100) in stage 1A, 64% (95% C.I. 53-74) in stage 1B, 27% (95% C.I. 10-44) in stage II, 18% (95% C.I. 4-32) in stage IIIA, and none in stages IIIB and IV. Dysphagia, fatigue, weight loss, palpable tumour, ascites and anaemia were related to a bad prognosis. Dyspepsia, vomiting and hematemesis were not related to the prognosis. Symptoms duration > 6 months were related to a better prognosis than short duration of symptoms < 2 months. The results from this hospital are in accordance with previous reports from the Western world.Acta Oncologica 01/2007; 46(3):308-15. DOI:10.1080/02841860600996462 · 3.71 Impact Factor
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ABSTRACT: Surgery is the main treatment for curing gastric cancer. Early diagnosis provides an excellent survival outcome via an improved detection of early gastric cancer and an improved resection rate. The extent of lymphadenectomy surgery has been under debate for a long time. In Eastern Asian countries, especially Japan, Korea, and Taiwan, gastrectomy with D2 dissection is routinely performed. By contrast, in most Western countries, gastrectomy with D1 dissection is performed, due to lower mortality and morbidity. Recently, acceptance of D2 surgery has increased in Western countries because: (1) modified D2 lymphadenectomy (preservation of pancreas and spleen) improves operative morbidity and mortality; (2) Western surgeons can be trained to performed D2 lymph node dissection on Western patients safely; and (3) D2 resection decreases locoregional recurrence and prolongs survival. Current guidelines in the United States and Europe suggest modified D2 dissection is recommended, but needs to be performed by high-volume centers with experienced surgeons. Adjuvant or perioperative chemotherapy should be prescribed for gastric cancer with Stage II or III disease, due to its marked benefits of reducing disease recurrence and increasing long-term survival. Patients with inoperable advanced gastric cancer should receive chemotherapy to improve their survival and quality of life if an acceptable performance status can be achieved. Targeted therapy with trastuzumab should be considered in patients with HER-2/neu overexpression who have a higher response rate and a longer survival.
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ABSTRACT: Background We have previously reported that laparoscopic approach improved short-term postoperative courses even for advanced gastric adenocarcinoma, but not morbidity, in comparison with open approach. The objective of this study was to determine the impact of the use of the surgical robot, da Vinci Surgical System, in minimally invasive radical gastrectomy on short-term outcomes. Methods A single institutional retrospective cohort study was performed (UMIN000011749). Five hundred twenty-six patients who underwent radical gastrectomy were enrolled. Eighty-eight patients who agreed to uninsured use of the surgical robot underwent robotic gastrectomy, whereas the remaining 438 patients who wished for laparoscopic (lap) approach with health insurance coverage underwent conventional laparoscopic gastrectomy. Results In the robotic group, morbidity (robotic vs lap 2.3 vs 11.4 %, p = 0.009) and hospital stay following surgery (robotic vs lap 14 [2-31] vs 15 [8-136] days, p = 0.021) were significantly improved, even though operative time (p = 0.003) and estimated blood loss (p = 0.026) were slightly greater. In particular, local (robotic vs lap 1.1 vs 9.8 %, p = 0.007) rather than systemic (robotic vs lap 1.1 vs 2.5 %, p = 0.376) complication rates were attenuated using the surgical robot. Multivariate analyses revealed that non-use of the surgical robot (OR 6.174 [1.454-26.224], p = 0.014), total gastrectomy (OR 4.670 [2.503-8.713], p p = 0.020) were the significant independent risk factors determining postoperative complications. Conclusions The use of the surgical robot might reduce surgery-related complications, leading to further improvement in short-term postoperative courses following minimally invasive radical gastrectomy.Surgical Endoscopy 07/2014; 29(3). DOI:10.1007/s00464-014-3718-0 · 3.31 Impact Factor