title: Surgical strategy for gastric cancer patients with liver cirrhosis: a retrospective cohort study.
abstract: BACKGROUND
  Recent studies have shown that radical gastrectomy with extended lymphadenectomy is feasible in gastric cancer patients with liver cirrhosis, but in those studies the main proportion was Child-Pugh class A patients. It is still difficult to choose reasonable surgical strategies for gastric cancer patients with cirrhosis, especially for Child-Pugh class B patients.
  
  
  METHODS
  We reviewed the medical records of patients with liver cirrhosis who had undergone radical gastrectomy between January 2001 and December 2012. The clinical characteristics, postoperative complications, mortality and long-term outcomes in the 58 patients were investigated.
  
  
  RESULTS
  Severe complications and postoperative mortality occurred more frequently in class B patients than in class A patients (P < 0.05). In patients with class A and B, the complications and mortality rate was 37.5% and 4.2% in D1 lymph node dissection group and 71.9% and 25% in D2 lymph node dissection group, respectively. Kaplan-Meier survival analysis showed longer survival for class A patients than for class B patients (P < 0.05). For class B patients with advanced gastric cancer, D2 lymph node dissection could not provide a longer survival than D1 lymph node dissection (P = 0.282).
  
  
  CONCLUSIONS
  Radical operation with D1 or D2 lymph node dissection can be tolerated in class A gastric cancer patients. D1 lymph node dissection is recommended in class B patients, and radical gastrectomy is very dangerous, even fatal for class C patients.
authors.affiliation: Department of General Surgery, Huashan Hospital, Shanghai Medical College, Fudan University, Shanghai 200010, China; Surgical Laboratory, Huashan Hospital, Shanghai Medical College, Fudan University, Shanghai 200010, China; Central Laboratory, Huashan North Hospital, Shanghai Medical College, Fudan University, Shanghai 201907, China.
authors.forename: Fenghua
authors.initials: F
authors.lastname: Guo
authors.affiliation: Department of Gynecology, Huashan North Hospital, Shanghai Medical College, Fudan University, Shanghai 201907, China; Central Laboratory, Huashan North Hospital, Shanghai Medical College, Fudan University, Shanghai 201907, China.
authors.forename: Shulan
authors.initials: S
authors.lastname: Ma
authors.affiliation: Department of General Surgery, Huashan Hospital, Shanghai Medical College, Fudan University, Shanghai 200010, China.
authors.forename: Shuo
authors.initials: S
authors.lastname: Yang
authors.affiliation: Department of General Surgery, Huashan Hospital, Shanghai Medical College, Fudan University, Shanghai 200010, China.
authors.forename: Yuanqiang
authors.initials: Y
authors.lastname: Dong
authors.affiliation: Department of General Surgery, Huashan Hospital, Shanghai Medical College, Fudan University, Shanghai 200010, China; Surgical Laboratory, Huashan Hospital, Shanghai Medical College, Fudan University, Shanghai 200010, China. Electronic address: LuoF2973@163.com.
authors.forename: Fen
authors.initials: F
authors.lastname: Luo
authors.affiliation: Department of General Surgery, Huashan Hospital, Shanghai Medical College, Fudan University, Shanghai 200010, China; Surgical Laboratory, Huashan Hospital, Shanghai Medical College, Fudan University, Shanghai 200010, China; Central Laboratory, Huashan North Hospital, Shanghai Medical College, Fudan University, Shanghai 201907, China. Electronic address: wzm2973@163.com.
authors.forename: Zhiming
authors.initials: Z
authors.lastname: Wang
mesh_terms: D000328:Adult; D000368:Aged; D005260:Female; D005743:Gastrectomy / Q000009:adverse effects* / Q000379:methods / Q000401:mortality; D006801:Humans; D053208:Kaplan-Meier Estimate; D008103:Liver Cirrhosis / Q000145:classification / Q000150:complications* / Q000401:mortality; D008197:Lymph Node Excision / Q000401:mortality; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000401:mortality*; D012189:Retrospective Studies; D013274:Stomach Neoplasms / Q000150:complications / Q000401:mortality / Q000601:surgery*; D016896:Treatment Outcome
keywords: Gastrectomy; Liver cirrhosis; Lymph node excision; Stomach neoplasms