Mortality after gastrectomy: a 10 year single institution experience

Although the general postoperative mortality rate after gastrectomy is decreasing worldwide, it still varies in individual centers and regions of the world. The objective of our work was to analyze the postoperative mortality rate at the Institute of Oncology, Vilnius University over a period of 10 years.

All patients who underwent total and subtotal gastrectomy for gastric cancer between 2003-2012 were retrospectively analyzed. Comprehensive evaluation of postoperative mortality was done according to the age, sex, comorbidities, BMI, tumor stage, extent or resection and lymphadenectomy, splenectomy, neoadjuvant chemotherapy and stage of disease. The causes of death were also analyzed.

The analysis of postoperative mortality for patients treated for gastric cancer in the period of 2003-2012 revealed that 1676 surgeries were performed with 54 lethal outcomes (3.22%). Complication rate was 20.58%. 1011 subtotal gastrectomies were performed with 24 lethal cases (2.37%). 30 patients died after 665 total gastrectomies (4.51%). The vast majority of deceased patients were older than 60 years (92.6%) and had advanced gastric cancer--stage III and IV (70.4%). 33 of 54 patients died from non-surgical complications (61.1%). Surgical complications accounted for 35.2% of dead patients, which totals 19 of 54 patients. Progression of cancer and cachexia caused the deaths of 3.7% of patients.

Elderly age, comorbidities, advanced stage of tumor and disease, and more radical surgery are related with higher postoperative mortality. The most common cause of death was pulmonary arterial thromboembolism. Therefore, risk assessment of venous thrombosis and thromboembolism prophylaxis should be an important component of gastric cancer surgical treatment.