title: Surgical modalities for gastric carcinoma with concurrent portal hypertension: a retrospective study.
abstract: OBJECTIVE
  Abdominal surgery in gastric carcinoma patients with concurrent portal hypertension (PHT) is highly risky due to liver function impairment. This study aimed to identify the optimal surgical modalities for the concomitant conditions
  
  
  METHODS
  Thirty patients with gastric adenocarcinoma and concurrent PHT who received radical (n=28) or palliative (n=2) gastrectomy plus D0/D1 (n=12) or D2 (n=18) lymphadenectomy, were reviewed. Logistic and Cox regression analysis were used to determine the correlation of predefined perioperative factors with surgical morbidity and overall survival (OS), respectively.
  
  
  RESULTS
  Sixteen (53.3%) patients experienced postoperative complications; the rates were 26.7% (4/15), 72.7% (8/11) and 100.0% (4/4) in patients with Child-Pugh classification (CPC) Class A, B and C, respectively. Five (16.7%) patients did not survive due to pulmonary embolism (n=1), anastomotic leakage (n=2), and multiple organ dysfunction syndrome (n=2). The median survival time was 15.0 months. TNM staging (p=0.027), CPC (p=0.048) and preoperative ascites (p=0.001) were significantly associated with OS as determined in the multivariate analysis.
  
  
  CONCLUSIONS
  Concomitant surgical treatment of PHT depends on the presence of hypersplenism and variceal bleeding risk. Baseline CPC, tumor TNM staging and the preoperative ascites predict the risks of surgical complications and long-term outcome.
authors.affiliation: Department of General Surgery, Shanghai Jiaotong University School of Medicine, Shanghai, China.
authors.forename: Qing
authors.initials: Q
authors.lastname: Xu
authors.forename: Lei
authors.initials: L
authors.lastname: Gu
authors.forename: Meng
authors.initials: M
authors.lastname: Luo
authors.forename: Zhi-Yong
authors.initials: ZY
authors.lastname: Wu
mesh_terms: D000230:Adenocarcinoma / Q000150:complications* / Q000473:pathology / Q000601:surgery*; D000328:Adult; D000368:Aged; D016009:Chi-Square Distribution; D015897:Comorbidity; D005260:Female; D005743:Gastrectomy / Q000379:methods*; D006801:Humans; D006975:Hypertension, Portal / Q000150:complications*; D008111:Liver Function Tests; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging; D016016:Proportional Hazards Models; D012189:Retrospective Studies; D012307:Risk Factors; D018709:Statistics, Nonparametric; D013274:Stomach Neoplasms / Q000150:complications* / Q000473:pathology / Q000601:surgery*; D015996:Survival Rate; D016896:Treatment Outcome