[Effect of extending the resection on postoperative complications of total gastrectomies: experience with 161...

Authors operated on 416 patients for gastric cancer between 1st of June 1991 and 31st of May 2001. Among them 305 lesions were resectable. So the resection rate was 73.3 per cent. Gastrectomy was performed in 161 patients (52.8 per cent of resections). Total gastrectomy with omentectomy was performed in 44 patients. In 96 patients splenectomy, in 19 patients splenectomy with the resection of the left side of the pancreas, in 33 patients distal esophageal resection and in 8 patients other organ resection was performed with total gastrectomy. Standard, two field lymphadenectomy has been performed only in the past few years. Uneventful recovery followed in 100 cases (62 per cent), 61 patients (38 per cent) suffered complications in the postoperative period. The most frequent surgical complication was anastomotic leak, which was observed in 8 patients (5 per cent). Septic complications, intraluminal bleeding, postoperative pancreatitis, intraabdominal bleeding, pancreatic fistula and small bowel obstruction were the most frequent surgical complications. Most general complications occurred in the cardiorespiratory system. In 9 patients reoperation was necessary. Eight patients (5 per cent) died in the postoperative period. In patients with extended gastrectomy significantly more complications occurred--compared with gastrectomy + omentectomy only. This could also be observed in patients with only splenectomy. If more organs were removed or resected with total gastrectomy and splenectomy, the complication rate increased only if pancreatic resection was performed. Mortality rate increased in these patients as well. The esophageal or other neighbouring organ (colon, small-bowel, liver, diaphragm etc.) resection had no influence on the postoperative morbidity or mortality. Extended operations should be performed, as the risk is acceptable, if there is hope for tumour clearance.