Higher morbidity and mortality after combined total gastrectomy and pancreaticosplenectomy for gastric cancer

Abstract

Total gastrectomy with pancreaticosplenectomy for gastric cancer has been proposed for facilitating lymph node dissection or for resection of direct tumor invasion to the pancreas, especially for T4 lesions. Its effectiveness in improving patient survival is still controversial, and higher morbidity and mortality with this procedure have been reported in several series. Such risks to patient survival were not observed in the Japanese series. Based on a prospective gastric cancer database maintained from 1987 to 1999 in our institution, the morbidity and mortality were analyzed in our series of pancreaticosplenectomies. A total of 1,278 patients with gastric cancer received gastrectomy in our surgical unit. Of these, 127 patients underwent curative total gastrectomy with pancreaticosplenectomy in order to facilitate lymph node dissection or removal of direct tumor invasion. Operative time, postoperative hospital stay, postoperative complications, and surgical mortality were analyzed. Compared to another 201 total gastrectomies, longer mean operative time (7.91 +/- 2.16 hours vs. 6.67 +/- 2.01, p <0.001) and postoperative hospital stay (median, 24.5 days vs. 17, p <0.001) for combined organ resection (pancreaticosplenectomy) were shown in this series. The major complication rate, including intraabdominal abscess, anastomotic leak, postoperative bleeding, pancreatitis/fistula, chylous leak, and general complications causing unstable vital signs (26.8% vs. 11.9%, p = 0.001), but not the mortality rate (6.3% vs. 4.8%, p = 0.608), was also shown to be higher in pancreaticosplenectomy patients. The most frequent fatal complication was intraabdominal abscess. However, more than 50% of complications occurred in the first 40 pancreaticosplenectomies (1987-1991); after adequate accumulation of experience, the total complication rate (57.5% vs. 35.6%, p = 0.021), major complication rate (40% vs. 20.7%, p = 0.022), and mortality rate (17.5% vs. 1.1%, p = 0.001) improved significantly in the remaining 87 patients (1991-1999). We therefore conclude that total gastrectomy with pancreaticosplenectomy can be performed by experienced surgeons with acceptable risk of morbidity and mortality.

Effect of surgical work volume on postoperative complication: superiority of specialized center in gastric cancer treatment

“…The rate of early postoperative complications is relatively high after gastric cancer surgery [10][11][12]. However, in the present study, POSSUM predicted morbidity satisfactorily, which means the surgical outcome was acceptable and was comparable to that in other specialized centers around the world [10,11,[13][14][15].…”

“…However, in the present study, POSSUM predicted morbidity satisfactorily, which means the surgical outcome was acceptable and was comparable to that in other specialized centers around the world [10,11,[13][14][15]. In addition, most of the complications were minor or moderate; and, in general, most of these complications (such as pyrexia of unknown origin) were considered to have little clinical importance.…”

Surgical Outcomes and Early Postoperative Complications in Locally Advanced Gastric Cancer

“…Lo et al suggested that total gastrectomy and pancreatico-splenectomy should be performed by experienced surgeons (21). The number of resected additional visceral organ is another factor on morbidity and mortality.…”

A systematic review of spleen and pancreas preservation in extended lymphadenectomy for gastric cancer

“…However, indications for splenectomy and Significance corresponds to the noted superscripts AL anastomotic leakage, N number, NR not reported, NS not significant, PD pancreaticoduodenectomy, PF pancreatic fistula, PP pancreaspreserving, PR pancreaticosplenectomy, pts patients, R0 resection with no residual tumor, SP spleen-preserving, SR splenectomy pancreatectomy in several of the articles included both extended lymphadenectomy and direct invasion [16,17,37,41,43,47,48]. Margin status is a strong prognostic indicator in patients undergoing surgery for gastric cancer, and positive margins are associated with decreased survival [14,42,45].…”