title: Clinical outcomes of patients with liver cirrhosis who underwent curative surgery for gastric cancer: a retrospective multi-center study.
abstract: We investigated early postoperative morbidity, mortality, and long-term outcomes in patients with liver cirrhosis (LC) who had undergone curative surgery for gastric cancer. The medical records of patients with LC who had undergone radical gastrectomy for gastric adenocarcinoma between January 1996 and September 2006 were retrospectively reviewed. A total of 57 patients were enrolled in this study. Forty-six patients (81%) were classified into Child's class A. In 22 patients (39%) postoperative complications developed, the most common being ascites (23%), followed by wound infection and hepatic encephalopathy. Postoperative ascites occurred more frequently in patients with Child's class B or C than in those with class A (63.6% vs 13%, P = 0.001). Massive ascites developed in 4 patients, 3 of whom had Child's class B and underwent D2 lymph node (LN) dissection, and 1 of whom had Child's class C and a D1 LN dissection. Postoperative mortality occurred in 5 patients (9%), with a significantly higher mortality rate for patients with Child's class B or C than for those with class A (27.2% vs 4.3%, P = 0.045). With a median follow-up of 32 months, the estimated 5-year survival rate for all patients was 54%. Regardless of the tumor depth, overall survival was longer for patients with Child's class A than for those with Child's class B or C. These results demonstrated that radical gastrectomy with extended LN dissection is feasible in patients with compensated LC. For patients with moderate to severe hepatic dysfunction, however, D1 or less extensive LN dissection may be the more reasonable surgical procedure.
authors.affiliation: Department of Internal Medicine, Kang Nam Sacred-Heart Hospital, Hallym University College of Medicine, 948-1 Daelim -1 Dong, Youngdungpo-Gu, Seoul, South Korea.
authors.forename: Hyun Joo
authors.initials: HJ
authors.lastname: Jang
authors.forename: Jung Han
authors.initials: JH
authors.lastname: Kim
authors.forename: Hun Ho
authors.initials: HH
authors.lastname: Song
authors.forename: Kyung Hee
authors.initials: KH
authors.lastname: Woo
authors.forename: Mi
authors.initials: M
authors.lastname: Kim
authors.forename: Sea Hyub
authors.initials: SH
authors.lastname: Kae
authors.forename: Jin
authors.initials: J
authors.lastname: Lee
authors.forename: Ji Wong
authors.initials: JW
authors.lastname: Cho
authors.forename: Jung Hun
authors.initials: JH
authors.lastname: Kang
authors.forename: Soon Il
authors.initials: SI
authors.lastname: Lee
authors.forename: Soo Jung
authors.initials: SJ
authors.lastname: Gong
authors.forename: Jung Ae
authors.initials: JA
authors.lastname: Lee
authors.forename: Dae Young
authors.initials: DY
authors.lastname: Zang
mesh_terms: D000230:Adenocarcinoma / Q000453:epidemiology / Q000473:pathology / Q000601:surgery*; D000328:Adult; D000368:Aged; D015897:Comorbidity; D005260:Female; D005743:Gastrectomy; D006801:Humans; D053208:Kaplan-Meier Estimate; D008103:Liver Cirrhosis / Q000453:epidemiology* / Q000401:mortality; D008197:Lymph Node Excision; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging; D011379:Prognosis; D012189:Retrospective Studies; D013274:Stomach Neoplasms / Q000453:epidemiology / Q000473:pathology / Q000601:surgery*; D016896:Treatment Outcome