Complications of total gastrectomy for gastric cancer--with special reference to anastomotic failure

We have reviewed the data on patients totally gastrectomized for gastric cancer during a 12 year period at our hospital. Our findings are summarized, as follows: 1. Advanced cases (stage III, IV) accounted for 85.4% (276/323) of them. Combined resection of other organs was performed on 87.6% of them. Twelve percent of the patients had peritoneal dissemination of P2 or higher grade and 5.9% hepatic metastases of H1 or higher grade. 2. Roux-en Y anastomosis was the most frequent (83.3%) reconstructive procedure. There were a total of 124 episodes of postoperative complications in 76 cases (23.5%). The lung and liver were often involved. Twenty-four cases (7.4%) suffered from postoperative anastomotic failure, which developed commonly at the site of oesophago-jejunostomy. Major leakage from this portion was the cause of death in 62.5% of the cases. The mortality rate was not notably different between the groups subjected to different reconstructive procedures or between the autosuture group (using an EEA stapler) and the hand suture group. The incidence of death due to the surgical intervention was 1.9%. 4. The 5-year survival after total gastrectomy was 25.2%, which was not necessarily satisfactory. However, it was significantly higher in the curative resection group than in the non-curative resection group (40.2% vs 3.3%).