Gastrectomy circumstances that influence early postoperative outcome.

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 R0 resection (71%). Postoperative complications occurred 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.