Total gastrectomy: Is the early postoperative morbidity and mortality influenced by the choice of surgical procedure?

Hassler, H; Bochud, R. C.; Nöthiger, F; Stafford, Amanda

doi:10.1007/bf01656105

Cited by 13 publications

(4 citation statements)

References 17 publications

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“…Our results revealed that the operative mortality with the extended total gastrectomy was not higher than with the proximal subtotal gastrectomy, and thus supported the resuits of Papachristou et al (1980). Although the operative mortality of total gastrectomy has been reported to be 10 to 20% (Hassler et al 1986), in our series it was only 1.9% with no differences in operative procedures and approaches. Therefore, extended total gastrectomy is considered to be a relatively safe operation and, in addition, enables us to perform curative resection for advanced cancers of the upper third of the stomach.…”

Section: Survivalsupporting

confidence: 81%

Surgical treatment for upper gastric cancers.

et al. 1987

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patients with gastric cancers were admitted to our surgical department. Among these cancers, upper gastric cancers were present in 190 (17%) patients. 54% of these upper gastric cancers had invaded the esophagus. For cancers of the gastro-esophageal junction, two approaches for surgical resection were employed. A thoraco-abdominal approach was used for cancers at a more advanced stage with more extensive esophageal involvement, while an abdominal approach was used for less advanced cancers. However, the overall survival rate was similar for each procedure; 40% and 39% , respectively. This is probably due to more complete lymphnode dissection that can be accmplished by the thoraco-abdominal approach.

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Section: Survivalsupporting

confidence: 81%

Surgical treatment for upper gastric cancers.

et al. 1987

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“…Although it is generally agreed that a total gastrectomy results in a higher surgical mortality than a distal subtotal gastrectomy, our present series in group B indicates no surgical deaths in the former procedure group when associated with splenectomy and caudal hemipancreatectomy (TSP: Table 2) but an overall 1.5% (2/137) surgical death rate in the total gastrectomy group (TSP + TS + T). In representative series, the surgical death rate in patients with total gastrectomy for gastric cancer regardless of curability ranges between 1.6% [7] and 11.1% [8] and, when restricted to the series dealing with the curative resection group, the surgical death rate ranges between 1.7% [5] and 42% [6].…”

Section: Discussionmentioning

confidence: 99%

A statistical evaluation of advancement in gastric cancer surgery with special reference to the significance of lymphadenectomy for cure

et al. 1988

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For the purpose of evaluating recent improvements in gastric cancer surgery, a comparative analysis was made between our previously reported series of 530 curative resection cases in a 10-year period from 1961 to 1970 (group A) and the present series of 481 curative resection cases in the following 10-year period from 1971 to 1980 (group B).During the latter period, curative resections made up 74.7% of all resections (481/644) for gastric cancer, and the 5-year survival rate was 65.9% (294/446). In group B, a total of 15,512 regional lymph nodes, an average of 32.6 per specimen (30 per specimen in group A and 37.9 per specimen in group C, the last 5 years from 1981 to 1985), were removed at surgery, examined histologically for metastases, and 11.0 % were found to be positive. Of 247 patients with advanced, transmural cancers, 80.6% had lymph node metastases. Those with negative nodes showed a 5-year survival rate of 71.4%, higher than the rate of 63.5% in group A, while those with positive nodes had a 5-year survival rate of 40.6 %, significantly higher (p < 0.05) than the 29.9% rate found in group A. The 5-year survivors with positive nodes in group B made up 72.2% of all 5-year survivors, this also being significantly higher (p < 0.05) than the 58.5% noted in group A. The surgical death rate was 1.0% (5/481) of patients in group B and 1.1% (3/274) in group C.In the present study, the significance of lymphadenectomy in curative gastric cancer surgery was well documented and the results indicated that curative gastric resection with extensive lymphadenectomy can be safely performed without increasing, but perhaps decreasing, surgical mortality.

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“…In Sweden, as well as in many countries, the Roux-en-Y procedure seems to be the most preferred reconstruction [t] in order to avoid alkaline reflux esophagitis. There is a tendency for a decrease in the postoperative morbidity and mortality rates after total gastrectomy in recent years [2][3][4][5][6][7] (Table 2). No doubt the operation carries a certain frequency of late complications resulting in weight loss and Reprint requests: Lars Olbe, M.D., Associate Professor, Department of Surgery II, Sahlgren's Hospital, S-413 45 Gothenburg, Sweden.…”

mentioning

confidence: 99%

Intestinal function after total gastrectomy and possible consequences of gastric replacement

Olbe

Lundell

1987

World j. surg.

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About half of the patients subjected to total gastrectomy experience weight loss. Malabsorption, particularly fat malabsorption, is a common feature after total gastrectomy. This may be due to shortened intestinal transit time and small bowel bacterial overgrowth, but is less often due to diarrhea or pancreatic exocrine insufficiency. Malabsorption is not closely related to weight loss, which is mainly caused by recurrent malignant diseases and a low postoperative calorie intake. The low calorie intake persists in half of the patients despite supervision of the patients by clinical nutritionists at the outpatient clinic. Roux-en-Y reconstruction of the esophago-intestinal canal has minimized the problem of postoperative reflux esophagitis. Severe postprandial symptoms are uncommon although epigastric oppression and fullness is an obligatory feature in the immediate postoperative period but successively vanishes in half of the patients.Gastric replacement by various enteric reservoirs has been used to improve nutrition after total gastrectomy. The effect of gastric replacement is, however, uncertain since no prospective, randomized studies are available. A gastric substitute seems to have only a marginal effect on meal size, daily caloric intake, and weight gain. A reservoir function of gastric substitutes has been documented but the effect on intestinal transit time is unknown. Stagnation of intestinal contents in a gastric replacement is common, but its significance for bacterial overgrowth, malabsorption, and clinical outcome remains to be determined.

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Total gastrectomy: Is the early postoperative morbidity and mortality influenced by the choice of surgical procedure?

Cited by 13 publications

References 17 publications

Surgical treatment for upper gastric cancers.

Surgical treatment for upper gastric cancers.

A statistical evaluation of advancement in gastric cancer surgery with special reference to the significance of lymphadenectomy for cure

Intestinal function after total gastrectomy and possible consequences of gastric replacement

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