Unique patterns and proper management of postgastrectomy bleeding in patients with gastric cancer

Bleeding after gastrectomy is a less frequent, but fatal complication. Because the pathophysiology and clinical manifestations differ considerably across cases, the exact outcome of postoperative bleeding is unclear. This study aimed to improve management practices for postgastrectomy bleeding by the analysis of risk factors and clinical patterns.

From January 2001 to December 2010, 5,739 patients underwent gastrectomy for gastric cancer at the National Cancer Center, Korea. Clinical data from patients with postoperative bleeding were obtained from a prospectively established database, and risk factors for bleeding were analyzed using multivariate binary logistic regression.

Incidence of the postoperative bleeding was 0.8% (n = 48) and the subsequent mortality rate was 10% (5/48). Majority of anastomotic bleeding occurred early within 1 day of the operation (5/7; 71%). It was successfully managed with conservative treatment in 3 patients, endoscopic intervention in 2, and relaparotomy in 2. Arterial bleeding occurred in 24 patients, with the main site being the splenic artery (11/24; 46%), and mostly manifested in the delayed period (median, 12 days). Fifteen of them underwent radiologic intervention, and 4 of these patients were referred for operation eventually. The other 9 patients underwent relaparotomy as first-line treatment. Independent risk factors for the bleeding were male (hazard ratio [HR] 2.253; 95% CI, 1.079-4.704), comorbidity (HR, 2.709; 95% CI, 1.440-5.095), previous abdominal operation (HR, 2.785; 95% CI, 1.322-5.867), and palliative surgery (HR, 4.142; 95% CI, 1.443-11.889).

Postgastrectomy bleeding can be managed properly considering its origin, severity, onset, and the risk factors.