Surgical strategy for gastric cancer patients with liver cirrhosis: a retrospective cohort study

Recent studies have shown that radical gastrectomy with extended lymphadenectomy is feasible in gastric cancer patients with liver cirrhosis, but in those studies the main proportion was Child-Pugh class A patients. It is still difficult to choose reasonable surgical strategies for gastric cancer patients with cirrhosis, especially for Child-Pugh class B patients.

We reviewed the medical records of patients with liver cirrhosis who had undergone radical gastrectomy between January 2001 and December 2012. The clinical characteristics, postoperative complications, mortality and long-term outcomes in the 58 patients were investigated.

Severe complications and postoperative mortality occurred more frequently in class B patients than in class A patients (P < 0.05). In patients with class A and B, the complications and mortality rate was 37.5% and 4.2% in D1 lymph node dissection group and 71.9% and 25% in D2 lymph node dissection group, respectively. Kaplan-Meier survival analysis showed longer survival for class A patients than for class B patients (P < 0.05). For class B patients with advanced gastric cancer, D2 lymph node dissection could not provide a longer survival than D1 lymph node dissection (P = 0.282).

Radical operation with D1 or D2 lymph node dissection can be tolerated in class A gastric cancer patients. D1 lymph node dissection is recommended in class B patients, and radical gastrectomy is very dangerous, even fatal for class C patients.