Early complications following total gastrectomy for gastric cancer*

Abstract

Routine use of stapling surgery, subspecialization in surgery, and better early intensive care monitoring and treatment could reduce the mortality rate.

Complicações pós-operatórias após gastrectomia total no câncer gástrico: análise de 300 doentes

“…The overall incidence rate is approximately 30%, ranging from 10% to 47%. They are divided into three distinct groups: immediate postoperative complications, which occur 30 days after surgery -secondary to anesthetic, surgical, early postoperative complications -, considered until six months after surgery, due to factors related to surgery and late complications, which occur six months after surgery, but still related to it 1,9,11,13 . The immediate postoperative complications overall are the most common respiratory illnesses, including atelectasis between 12 and 20%, pneumonia by about 9%, respiratory failure in an average of 3% and pulmonary embolism 0.05%.…”

“…Among the local complications are cited in the eviscerations about 4% and abscess and wound infection totaling about 3%. Other less frequent complications are referred to venous thrombosis of lower limbs in 2%, 1% in subphrenic abscess and acute pancreatitis in 1% of cases 1,8,11 . Fistulas of the esophagus-jejunal anastomosis are the most concern to the surgeon, since its incidence is quite high in literature, ranging from 10 to 22%, significantly increasing the length of hospitalization time and causing considerable morbidity and mortality.…”

“…Jejunostomy left routinely in these patients is not always sufficient to provide the required caloric intake and fluid and electrolyte balance essential. The others duodenal, jejuno-jejunal and pancreatic fistulas range from 2% to 5%, are easier to handle and have lower morbidity 1,2,6,8,11,13 . Among the postoperative complications early and late, are cited stenosis of the esophagus-jejunal anastomosis ranging from 0.05 to 6%, with an incidence slightly higher if performed with mechanical staplers.…”

“…Furthermore, it requires hospitalization time longer than the other surgeries, and semi-intensive and intensive postoperative cares, infection control, and general maintenance of the nutritional condition 11 . The most important complications are fistulas and dehiscence of the esophageal-jejunal anastomosis, that literature shows records from 7 to 15% 1,2 . The dehiscence of the anastomosis is associated with high mortality, reaching 30% in some series, and it is very important to the surgeon experience and learning curve to minimize this complication.…”

Endoscopic vacuum sponge therapy for esophageal defects

“…In any case, drainage of the wound area is necessary [4][5][6][7]. These treatment options, however, are associated with high rates of morbidity and mortality [8,9].…”