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Postoperative complications requiring relaparotomies after 700 gastretomies performed for gastric cancer
I B Shchepotin1, S R Evans, V A Chorny
1Department of Surgery, Georgetown University Medical Center, Washington, DC, USA.
Background:
Prevention of fatal postoperative complications and improved management of patients with complications are important means of increased survival in gastric cancer patients.
Patients And Methods:
A study of 700 patients undergoing gastrectomy was performed to examine factors that contributed to a high rate of postoperative complications.
Results:
Of 700 patients undergoing gastrectomy for adenocarcinoma, 40 (5.7%) underwent reexploration because of serious complications. The frequency of the relaparotomies varied from 2.1% and 4.4% after regular subtotal and total gastrectomies, respectively, to 20% and 30.4% after palliative and conventional total gastrectomies, respectively. The complications that required reexploration most frequently were anastomotic leakage and incompetence of sutures (11, 27.5%), intra-abdominal abscesses (8, 20%), and pancreatic necrosis (7, 17.5%). A combination of preventive measures allowed the attainment of low rates of esophagojejunal anastomotic leakage (0.8%).
Conclusion:
We believe that the decision to perform an urgent reexploration, based on clinical findings, should generally be made by a group of experienced surgeons (not only the primary surgeon). Timely relaparotomy prevented death in 37.5% of the patients with serious acute postoperative complications.