Postoperative complications requiring relaparotomies after 700 gastretomies performed for gastric cancer.
BACKGROUND
Prevention of fatal postoperative complications and improved management of patients with complications are important means of increased survival in gastric cancer patients.


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%).


CONCLUSIONS
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.
Shchepotin
I B
IB
Department of Surgery, Georgetown University Medical Center, Washington, DC, USA.
Evans
S R
SR
Chorny
V A
VA
Shabahang
M
M
Buras
R R
RR
Nauta
R J
RJ
D000230:Adenocarcinoma / Q000401:mortality / Q000601:surgery; D000328:Adult; D000368:Aged; D005260:Female; D006801:Humans; D007813:Laparotomy; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000401:mortality / Q000601:surgery*; D012086:Reoperation; D013274:Stomach Neoplasms / Q000401:mortality / Q000601:surgery*; D015996:Survival Rate