Skip to main content
Log in

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

  • Original Scientific Reports
  • Published:
World Journal of Surgery Aims and scope Submit manuscript

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.

Résumé

La gastrectomie totale avec splénopancréatectomie pour cancer gastrique a été proposée pour faciliter la lymphadénectomie ou pour Texérèse des lésions envahissant le pancréas, surtout en cas de lésion T4. Si son efficience dans l’amélioration de la survie est toujours sous discussion, on a rapporté, au contraire des séries japonaises, une plus forte morbidité et mortalité, voire même une survie moindre, avec ce procédé. Basé sur une banque de données constituée prospectivement sur le cancer gastrique entre 1987 et 1999, la morbidité et la mortalité de la splénopancréatectomie ont été analysées chez 1278 patients gastrectomisés pour cancer gastrique. Parmi eux, 127 patients ont eu une gastrectomie totale à visée curatrice associée à une splénopancréatectomie soit pour faciliter la lymphadénectomie soit en raison d’un envahissement pancréatique. Le temps opératoire, la durée de séjour hospitalier postopératoire, les complications postopératoires et la mortalité chirurgicale ont été analysés. Comparés à 201 autres gastrectomie totales, on a observé un temps opératoire moyen (7.91±2.16 heures vs. 6.67±2.01, p<0.001) et une durée de séjour postopératoire (médiane, 24.5 jours vs. 17, p<0.001) plus longs en cas de résection combinée (splénopancréatectomie). On a observé che les patients ayant eu une splénopancréatectomie, un taux de complication majeure plus élevé y compris pour les absès intra-abdominaux, les fuites anastomotiques, l’hémorragie postopératoire, la pancréatite/fistule, les fuites chyleuses et d’autres complications responsables d’instabilité des signes vitaux (26.8% vs. 11.9%, p=0.001), mais pas du taux de mortalité (6.3% vs. 4.8%, p=0.608). La complication fatale la plus fréquente a été l’absès intra-abdominal. Cependant, plus de 50% des complications se sont révélées pendant les 40 premières interventions (1987–1991). Après une certaine expérience, ona noté une amélioration dans le taux de complications globales (57.5% vs. 35.6%, p=0.021), de complications majeures (40% vs. 20.7%, p=0.022) et de mortalité (17.5% vs. 1.1%, p=0.001) chez les 87 patients suivants (1991-). Ainsi la gatrectomie totale avec splénopancréatectomie peut être réalisée avec une morbidité et une mortalité acceptables lorsqu’il agit de chirurgiens expérimentés.

Resumen

Se pensó que, para facilitar la disección y extirpación de las adenopatías linfáticas o incluso resecar la parte tumoral que invade el páncreas, podría realizarse, junto con la gastrectomía total, una esplenopancreatectornía, sobre todo en los cánceres gástricos T-4, Dado que esta teoría no ha demostrado todavía su eficacia por lo que al incremento de la supervivencia se refiere y que en diversos trabajos cursa con alta mortalidad y morbilidad, (no observada sin embargo, en las publicaciones japonesas), tan drástico proceder sigue siendo polémico. Se analiza nuestra experiencia basada en un estudio prospectivo realizado entre 1987 a 1999 sobre la morbilidad y mortalidad registrada en resecciones totales gástricas, completadas o no con esplenopancreatectornía, en pacientes con cáncer gástrico. En total 1,278 pacientes fueron gastrectomizados en nuestro Servicio por cáncer de estómago. De todos ellos 127 fueron sometidos, con fines curativos, a una gastrectomía total con esplenopancreatectornía para conseguir una mayor radicalidad tanto en la resección ganglionar como en la infiltración tumoral pancreática. Analizamos: la duración de la operación, estancia hospitalaria, complicaciones postoperatorias y mortalidad; comparando este tratamiento radical, con 201 gastrectomies totales constatamos que: la duración de la intervención (7.91±2.16 vs 6.67±2.01 horas, p<0.001) y la estancia hospitalaria media (24.5 días vs 17, p<0.001) fueron estadísticamente significativas. Igualmente observamos un porcentaje major de complicaciones tales como: absceso intraabdominal, dehiscencia anastomótica, hemorragia postoperatoria, pancreatitis o fístula pancreática, derrame quiloso y complicaciones generales determinantes de inestabilidad de los signos vitales (26.8% vs 11.9%, p=0.001). Sin embargo, la mortalidad no fue significativamente diferente entre ambas intervenciones (6.3% vs 4.8%, p=0.608). Cuando la gastrectomía total se completa con una esplenopancreatectornía, la complicación más frecuente y de fatal evolución fue el absceso intraabdominal. Sin embargo, más del 50% de estas complicaciones se registraron durante las 40 primeras esplenopancreatectomías (1987–1991); tras adquirir una experiencia adecuada en la 87 intervencionas restantes (1991-) el número total de complicaciones disminuyó (57.5% vs 35.6%, p=0.021); las complicaciones graves fueron menores (40% vs 20.7%, p=0.022) así como la mortalidad (17.5% vs 1.1%, p=0.001). Por tanto, la gastrectomía total asociada a una esplenopancreatectornía puede realizarse, por cirujanos experimentados, con una aceptable morbi-mortalidad.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

  1. Shchepotin IB, Chorny VA, Nauta RJ, et al. Extended surgical resection in T4 gastric cancer. Am. J. Surg. 1998;175:123–126

    Article  PubMed  CAS  Google Scholar 

  2. Bonenkamp JJ, Songun I, Hermans J, et al. Randomized comparison of morbidity after Dl and D2 dissection for gastric cancer in 996 Dutch patients. Lancet 1995;345:745–748

    Article  PubMed  CAS  Google Scholar 

  3. Degiuli M, Sasako M, Ponti A, et al. Morbidity and mortality after D2 gastrectomy for gastric cancer: results of the Italian Gastric Cancer Study Group prospective multicenter surgical study. J. Clin. Oncol. 1998;16:1490–1493

    PubMed  CAS  Google Scholar 

  4. Cuschieri A, Payers P, Fielding J, et al. Postoperative morbidity and mortality after Dl and D2 resections for gastric cancer: preliminary results of the MRC randomized controlled surgical trial. The Surgical Cooperative Group. Lancet 1996;347:995–999

    Article  PubMed  CAS  Google Scholar 

  5. Cuschieri A, Weeden S, Fielding J, et al. Patient survival after Dl and D2 resections for gastric cancer: long-term results of the MRC randomized surgical trial. Br. J. Cancer 1999:79:1522–1530

    Article  PubMed  CAS  Google Scholar 

  6. Akita N, Iwanaga T, Furukawa H, et al. Significance of total gastrectomy with preserving pancreas and splenectomy for superior pancreatic lymph node dissection for gastric carcinoma. Jpn. J. Gastroenterol/Surg. 1989;22:2236–2241

    Google Scholar 

  7. Kinoshita T, Maruyama K, Sasako M, et al. A comparison of distal pancreatectomy and the pancreas-preserving operation for advanced gastric cancer in regard to the quality of life of the patients and the treatment results. Jpn. J. Gastroenterol. Surg. 1992;25:2236–2241

    Google Scholar 

  8. Macintyre IMC, Akoh JA. Improving survival in gastric cancer: review of operative mortality in English language publications from 1970. Br. J. Surg. 1991;78:773–778

    Article  Google Scholar 

  9. Wu CW, Hsieh MC, Lo SS, et al. Morbidity and mortality after radical gastrectomy for patients with carcinoma of the stomach. J. Am. Coll. Surgeons 1995;181:26–32

    CAS  Google Scholar 

  10. Kitamura K, Nishida S, Ichikawa D, et al. No survival benefit from combined pancreaticosplenectomy and total gastrectomy for gastric cancer. Br. J. Surg. 1999;86:119–122

    Article  PubMed  CAS  Google Scholar 

  11. Smith JW, Shiu MH, Kelsey L, et al. Morbidity of radical lymphadenectomy in the curative resection of gastric carcinoma. Arch. Surg. 1991;126:1469–1473

    PubMed  CAS  Google Scholar 

  12. Yonemura Y, Kawamura T, Nojima N, et al. Postoperative results of left upper abdominal evisceration for advanced gastric cancer. Hepato-gastroenterology 2000;47:571–574

    PubMed  CAS  Google Scholar 

  13. Kitamura K, Yamaguchi T, Sawai K, et al. Chronologic changes in the clinicopathologic findings and survival of gastric cancer patients. J. Clin. Oncol. 1997;15:3471–3480

    PubMed  CAS  Google Scholar 

  14. Wu CW, Chen Y, Hsieh MJ, et al. Use of a modified Foley catheter for continuous irrigation of intraabdominal abscess. Br. J. Surg. 1992; 79:1296

    Article  PubMed  CAS  Google Scholar 

  15. Siewart JR, Bottcher K, Stein HJ, et al. Relevant prognostic factors in gastric cancer, ten-year results of the German Gastric Cancer Study. Ann. Surg. 1998;228:449–461

    Article  Google Scholar 

Download references

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Su-Shun Lo M.D..

Additional information

Published Online: March 26, 2002

Rights and permissions

Reprints and permissions

About this article

Cite this article

Lo, SS., Wu, CW., Shen, KH. et al. Higher morbidity and mortality after combined total gastrectomy and pancreaticosplenectomy for gastric cancer. World J. Surg. 26, 678–682 (2002). https://doi.org/10.1007/s00268-001-0289-8

Download citation

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00268-001-0289-8

Keywords

Navigation