[Postoperative morbidity and in-hospital mortality of gastrectomy due to gastric adenocarcinoma: a report of 50 years].
OBJECTIVE
Determine the postoperative morbidity and in-hospital mortality of gastrectomy due to gastric cancer.


METHODS
The study involved the review of the clinical records of all patients with histologically confirmed diagnostic of gastric adenocarcinoma, which underwent a gastrectomy at the Peruvian Institute of Neoplastic Diseases between January 1950 and December 1999. During that period, 2,033 gastrectomies were performed, 503 of which were total gastrectomies and 1,447 were distal subtotal gastrectomies. Postoperative morbidity of total and distal subtotal gastrectomy dropped from 23.7% and 14.3% during the 1950 decade, to 19.8% and 7.4% during the 1990 decade, respectively, while the in-hospital mortality of total and subtotal gastrectomy dropped from 28.9% and 19.4% during the 50s to 4.4% and 2.2% during the 90's. The most common complications were the esophagojejunal, gastrojejunal and duodenal fistulas, respiratory infections, intra-abdominal abscesses, pancreatic fistula, early intestinal obstruction, hemorrhage from the anastomosis site and surgical site infection.


RESULTS
Multivariate logistics regression analysis showed that the risk factors for in-hospital mortality of total gastrectomy were hypoalbuminemia, intraoperative blood transfusion and re-resection (OR: 2.4, 5.9 and 1.7, respectively). For distal subtotal gastrectomy, the risk factors for in-hospital mortality were hypoalbuminemia, intraoperative blood transfusion, splenectomy and re-resection (OR: 2.6, 2.46, 2.42 and 6.3, respectively).


CONCLUSIONS
Based on our results, the in-hospital mortality risk depends on the postoperative variables (hypoalbuminemia, intraoperative blood transfusion, splenectomy and re-resection) more than on the pre-operative variables, beyond the surgeon's control (age, sex, clinical stage, etc.).
Departamento de Abdomen, Instituto de Enfermedades Neoplásicas, Lima, Peru.
Eloy
E
Ruiz
Carlos
C
Payet
Juan Antonio
JA
Montalbetti
Juan
J
Celis
Eduardo
E
Payet
Francisco
F
Berrospi
Ivan
I
Chavez
Frank
F
Young
D000230:Adenocarcinoma / Q000401:mortality* / Q000601:surgery; D000368:Aged; D002423:Cause of Death; D005260:Female; D005743:Gastrectomy / Q000401:mortality*; D017052:Hospital Mortality / Q000639:trends*; D006801:Humans; D008297:Male; D009367:Neoplasm Staging; D011183:Postoperative Complications; D012189:Retrospective Studies; D012307:Risk Factors; D013274:Stomach Neoplasms / Q000401:mortality* / Q000601:surgery; D016896:Treatment Outcome