Surgical modalities for gastric carcinoma with concurrent portal hypertension: a retrospective study

Abdominal surgery in gastric carcinoma patients with concurrent portal hypertension (PHT) is highly risky due to liver function impairment. This study aimed to identify the optimal surgical modalities for the concomitant conditions

Thirty patients with gastric adenocarcinoma and concurrent PHT who received radical (n=28) or palliative (n=2) gastrectomy plus D0/D1 (n=12) or D2 (n=18) lymphadenectomy, were reviewed. Logistic and Cox regression analysis were used to determine the correlation of predefined perioperative factors with surgical morbidity and overall survival (OS), respectively.

Sixteen (53.3%) patients experienced postoperative complications; the rates were 26.7% (4/15), 72.7% (8/11) and 100.0% (4/4) in patients with Child-Pugh classification (CPC) Class A, B and C, respectively. Five (16.7%) patients did not survive due to pulmonary embolism (n=1), anastomotic leakage (n=2), and multiple organ dysfunction syndrome (n=2). The median survival time was 15.0 months. TNM staging (p=0.027), CPC (p=0.048) and preoperative ascites (p=0.001) were significantly associated with OS as determined in the multivariate analysis.

Concomitant surgical treatment of PHT depends on the presence of hypersplenism and variceal bleeding risk. Baseline CPC, tumor TNM staging and the preoperative ascites predict the risks of surgical complications and long-term outcome.