Gastrectomy circumstances that influences early postoperative outcome

Roderich E. Schwarz, Kathyrn Zagala-Nevarez

Research output: Contribution to journalArticle

13 Citations (Scopus)

Abstract

Background/Aims: Despite decreasing mortality, gastric resection is still a procedure of significant morbidity. Methodology: Factors predicting post-gastrectomy outcome over 3 years in a tertiary care cancer center, single-surgeon experience were analyzed. Results: Thirty-four patients who underwent total or partial gastrectomy at the City of Hope Cancer Center between 11/1996 and 11/1999 were analyzed. There were 21 males and 13 females, with a median age of 61 years (range: 36-97). Diagnoses included gastric malignancy (n = 28), hemorrhage from diffuse gastritis (n = 4), gastric necrosis with perforation (n = 1), and an aortogastric fistula (n = 1). The operative intent was curative in 22, and palliative in 6 cancer patients. Procedures included total (n = 14), subtotal (n = 9), distal (n = 8), and proximal gastrectomy (n = 3). Reconstruction techniques were Roux-Y (n = 25), BII (n = 5), primary esophagogastric anastomosis (n-3), and primary gastric closure (n = 1). Twenty patients had prior abdominal operations (59%); 10 underwent resection of additional organs (29%), including 2 splenectomies. The median lymph node count was 24, and 20 cancer patients had a RO resection (71%). Postoperative complications occured in 14 patients (41%; major: 26%), with 3 in-hospital deaths and one 90-day fatality (90-day mortality: 12%). Predictors of complications were benign diagnosis (p = 0.01), emergency procedure (p = 0.01), and splenectomy (prior or concurrent) (p = 0.02). Cancer diagnosis (vs. benign) and nonemergent gastrectomy (vs. emergency) were each associated with lower mortality (4 vs. 50%, p = 0.01), median length of stay (12 vs. 19 d, p = 0.02), and tube feed duration (7 vs. 194 d, p = 0.04). Gastrectomies for cancer with curative intent (vs. palliative or therapeutic) had no mortality (p = 0.004), a major complication rate of 14% (p = 0.02), and a median stay of 12 days (p = n.s). For patients with gastric cancer, pathologic stage was the only multivariate predictor of survival (p = 0.04) at a median follow-up of 9 months (15 for survivors); a median survival for patients with potentially curable disease (stage IA-IIIB) has not yet been reached. Conclusions: Gastrectomies for cancer, especially when done electively with curative intent, can lead to excellent postoperative recovery. Palliative gastrectomies or emergency procedures for "benign" conditions have significantly more complicated outcomes.

Original languageEnglish (US)
Pages (from-to)1742-1746
Number of pages5
JournalHepato-Gastroenterology
Volume49
Issue number48
StatePublished - Nov 2002

Fingerprint

Gastrectomy
Neoplasms
Stomach
Emergencies
Mortality
Splenectomy
Survival
Gastritis
Tertiary Care Centers
Stomach Neoplasms
Fistula
Survivors
Length of Stay
Necrosis
Lymph Nodes
Hemorrhage
Morbidity

Keywords

  • Elective surgery
  • Gastrectomy
  • Gastric cancer
  • Postoperative complications
  • Surgical palliation

ASJC Scopus subject areas

  • Gastroenterology

Cite this

Schwarz, R. E., & Zagala-Nevarez, K. (2002). Gastrectomy circumstances that influences early postoperative outcome. Hepato-Gastroenterology, 49(48), 1742-1746.

Gastrectomy circumstances that influences early postoperative outcome. / Schwarz, Roderich E.; Zagala-Nevarez, Kathyrn.

In: Hepato-Gastroenterology, Vol. 49, No. 48, 11.2002, p. 1742-1746.

Research output: Contribution to journalArticle

Schwarz, RE & Zagala-Nevarez, K 2002, 'Gastrectomy circumstances that influences early postoperative outcome', Hepato-Gastroenterology, vol. 49, no. 48, pp. 1742-1746.
Schwarz, Roderich E. ; Zagala-Nevarez, Kathyrn. / Gastrectomy circumstances that influences early postoperative outcome. In: Hepato-Gastroenterology. 2002 ; Vol. 49, No. 48. pp. 1742-1746.
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KW - Gastrectomy

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