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Is Laparoscopy-assisted Radical Gastrectomy Safe in Patients with Child-Pugh Class A Cirrhosis?
Sin Jae Kang1, Mi Ran Jung1, Oh Cheong1
1Department of Surgery, Chonnam National University Medical School, Gwangju, Korea.
Insights
Radical gastrectomy for gastric cancer in patients with liver cirrhosis (Child-Pugh class A) showed no postoperative mortality. Laparoscopic gastrectomy is a safe option for these patients.
Area of Science:
- Gastroenterology
- Surgical Oncology
- Hepatology
Background:
- Liver cirrhosis poses significant risks for major surgery.
- Gastric cancer management in cirrhotic patients requires careful consideration of surgical approach.
- Assessing early postoperative outcomes is crucial for patient selection and surgical planning.
Purpose of the Study:
- To investigate early postoperative morbidity and mortality in liver cirrhosis patients undergoing radical gastrectomy for gastric cancer.
- To compare outcomes between open and laparoscopic gastrectomy in this specific patient group.
Main Methods:
- Retrospective review of 41 Child-Pugh class A patients with liver cirrhosis who underwent radical gastrectomy.
- Analysis of postoperative complications including ascites, hemorrhage, and wound infection.
- Statistical correction for confounding factors like cancer stage between open and laparoscopic groups.
Main Results:
- Overall postoperative complication rate was 53.7%, with ascites being the most common (46.3%).
- No postoperative mortality was observed in any patient.
- No statistically significant difference in major complications (ascites, hemorrhage, wound infection, intra-abdominal abscess) between open and laparoscopic gastrectomy after adjusting for cancer stage.
Conclusions:
- Laparoscopic gastrectomy is a feasible and safe surgical procedure for selected patients with moderate hepatic dysfunction (Child-Pugh class A) undergoing radical gastrectomy for gastric cancer.
- The findings support the use of minimally invasive approaches in cirrhotic patients when oncologically indicated.
Purpose:
We investigated early postoperative morbidity and mortality in patients with liver cirrhosis who had undergone radical gastrectomy for gastric cancer.
Materials And Methods:
We retrospectively reviewed the medical records of 41 patients who underwent radical gastrectomy at the Chonnam National University Hwasun Hospital (Hwasun-gun, Korea) between August 2004 and June 2009. There were few patients with Child-Pugh class B or C; therefore, we restricted patient selection to those with Child-Pugh class A.
Results:
Postoperative complications were observed in 22 (53.7%) patients. The most common complications were ascites (46.3%), postoperative hemorrhage (22.0%) and wound infection (12.2%). Intra-abdominal abscess developed in one (2.4%) patient who had undergone open gastrectomy. Massive ascites occurred in 4 (9.8%) patients. Of the patients who underwent open gastrectomy, nine (21.9%) patients required blood transfusions as a result of postoperative hemorrhage. However, most of these patients had advanced gastric cancer. In contrast, most patients who underwent laparoscopic gastrectomy had early stage gastric cancer, and when the confounding effect from the different stages between the two groups was corrected statistically, no statistically significant difference was found. There was also no significant difference between open and laparoscopic gastrectomy in the occurrence rate of other postoperative complications such as ascites, wound infection, and intra-abdominal abscess. No postoperative mortality occurred.
Conclusions:
Laparoscopic gastrectomy is a feasible surgical procedure for patients with moderate hepatic dysfunction.
