title: The delayed massive hemorrhage after gastrectomy in patients with gastric cancer: characteristics, management opinions and risk factors.
abstract: OBJECTIVE
  This study was designed to investigate the clinical features of delayed massive hemorrhage (DMH) after gastrectomy in patients with gastric cancer (GC).
  
  
  METHODS
  This study retrospectively reviewed 1536 GC patients with major gastrectomy between 1998 and 2011. Based on the time onset of postoperative bleeding, patients were divided into early postoperative hemorrhage (EPH), delayed massive hemorrhage (DMH), and no-bleeding groups. Postoperative mortality, bleeding treatment, and risk factors of hemorrhage were explored.
  
  
  RESULTS
  In sum, 15 (0.9%) patients suffered from DMH, with three (20%) dead cases. None of 18 (1.2%) patients with EPH died, but there were three dead cases in no-bleeding group. DMH had more extra-intestinal bleeding (P = 0.037) than EPH. Angiographic embolization was performed in 12 (80%) of DMH patients and successful in ten cases. Surgical procedures were applied in only two embolization-failed cases. Extended lymphadenectomy (P = 0.038), vascular skeletonization (P = 0.012) and advanced TNM stage (P < 0.001) were correlated with DMH.
  
  
  CONCLUSIONS
  DMH can be successfully managed with angiographic embolization, followed by alternative surgery. Extensive lymphadenectomy and vascular skeletonization should be discreetly performed during gastrectomy.
authors.affiliation: Department of Gastrointestinal and Pancreatic Surgery, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, PR China.
authors.forename: W
authors.initials: W
authors.lastname: Song
authors.affiliation: Department of Gastrointestinal and Pancreatic Surgery, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, PR China.
authors.forename: Y
authors.initials: Y
authors.lastname: Yuan
authors.affiliation: Department of Gastrointestinal and Pancreatic Surgery, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, PR China.
authors.forename: J
authors.initials: J
authors.lastname: Peng
authors.affiliation: Department of Gastrointestinal and Pancreatic Surgery, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, PR China.
authors.forename: J
authors.initials: J
authors.lastname: Chen
authors.affiliation: Department of Gastrointestinal and Pancreatic Surgery, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, PR China.
authors.forename: F
authors.initials: F
authors.lastname: Han
authors.affiliation: Department of Gastrointestinal and Pancreatic Surgery, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, PR China.
authors.forename: S
authors.initials: S
authors.lastname: Cai
authors.affiliation: Department of Gastrointestinal and Pancreatic Surgery, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, PR China.
authors.forename: W
authors.initials: W
authors.lastname: Zhan
authors.affiliation: Department of Gastrointestinal and Pancreatic Surgery, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, PR China. Electronic address: YulongH.SYSU@gmail.com.
authors.forename: Y
authors.initials: Y
authors.lastname: He
mesh_terms: D000328:Adult; D000368:Aged; D000792:Angiography; D002277:Carcinoma / Q000601:surgery*; D015331:Cohort Studies; D004621:Embolization, Therapeutic; D005260:Female; D005743:Gastrectomy / Q000379:methods*; D006471:Gastrointestinal Hemorrhage / Q000453:epidemiology* / Q000628:therapy; D006801:Humans; D008197:Lymph Node Excision / Q000379:methods*; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging; D019106:Postoperative Hemorrhage / Q000453:epidemiology* / Q000628:therapy; D012189:Retrospective Studies; D012307:Risk Factors; D013274:Stomach Neoplasms / Q000473:pathology / Q000601:surgery*; D013997:Time Factors; D016896:Treatment Outcome
keywords: Delayed massive hemorrhage; Embolization; Gastrectomy; Gastric cancer; Risk factors