Skip to main content
SpringerLink
Log in

Managing Early and Late Postoperative Complications Following Gastric Surgery

  • Chapter
  • First Online:
Gastric Cancer

  • 2699 Accesses

Abstract

Gastric cancer surgery is associated with morbidity rates of 20–30 % and 30-day mortality rates of 4–5 %, based on multi-institutional quality improvement program data. Patients who undergo total gastrectomy have higher morbidity and mortality rates than do patients who undergo subtotal gastrectomy. Resection of adjacent organs also increases the risk of major postoperative complications. Frequently reported complications after gastrectomy include wound and intra-abdominal infection, dehiscence, pulmonary complications, myocardial infarction, thromboembolic complications, and anastomotic leakage. In addition to the standard early postoperative complications of major abdominal surgery, patients undergoing gastric resection are prone to several unique clinical syndromes often referred to as postgastrectomy syndromes. Although these syndromes were more common when peptic ulcer disease was frequently treated with surgery, these syndromes may also manifest in long-term survivors of gastric cancer and therefore are important survivorship issues. Postgastrectomy syndromes and late complications discussed in this chapter include dumping syndrome, afferent limb syndrome, efferent limb syndrome, Roux stasis syndrome, bile reflux gastritis, and postvagotomy diarrhea.

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

Access this chapter

Log in via an institution
Chapter
USD 29.95
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
eBook
USD 109.00
Price excludes VAT (USA)
  • Available as EPUB and PDF
  • Read on any device
  • Instant download
  • Own it forever
Hardcover Book
USD 199.99
Price excludes VAT (USA)
  • Durable hardcover edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info

Tax calculation will be finalised at checkout

Purchases are for personal use only

Institutional subscriptions

References

  1. Bonenkamp JJ, Hermans J, Sasako M, et al. Extended lymph-node dissection for gastric cancer. N Engl J Med. 1999;340(12):908–14.

    Article  CAS  PubMed  Google Scholar 

  2. Cuschieri A, Fayers P, Fielding J, et al. Postoperative morbidity and mortality after D1 and D2 resections for gastric cancer: preliminary results of the MRC randomised controlled surgical trial. The Surgical Cooperative Group. Lancet. 1996;347(9007):995–9.

    Article  CAS  PubMed  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(4):1490–3.

    CAS  PubMed  Google Scholar 

  4. Cunningham D, Allum WH, Stenning SP, et al. Perioperative chemotherapy versus surgery alone for resectable gastroesophageal cancer. N Engl J Med. 2006;355(1):11–20.

    Article  CAS  PubMed  Google Scholar 

  5. Wang Z, Chen J, Su K, et al. Abdominal drainage versus no drainage post gastrectomy for gastric cancer. Cochrane Database Syst Rev. 2011;10(8):CD008788.

    Google Scholar 

  6. Papenfuss WA, Kukar M, Oxenberg J, et al. Morbidity and mortality associated with gastrectomy for gastric cancer. Ann Surg Oncol. 2014;21:3008–14.

    Article  PubMed  Google Scholar 

  7. Grossmann EM, Longo WE, Virgo KS, et al. Morbidity and mortality of gastrectomy for cancer in Department of Veterans Affairs Medical Centers. Surgery. 2002;131(5):484–90.

    Article  PubMed  Google Scholar 

  8. Kubo M, Sasako M, Gotoda T, et al. Endoscopic evaluation of the remnant stomach after gastrectomy: proposal for a new classification. Gastric Cancer. 2002;5(2):83–9.

    Article  PubMed  Google Scholar 

  9. Lang H, Piso P, Stukenborg C, et al. Management and results of proximal anastomotic leaks in a series of 1114 total gastrectomies for gastric carcinoma. Eur J Surg Oncol. 2000;26(2):168–71.

    Article  CAS  PubMed  Google Scholar 

  10. Sierzega M, Kolodziejczyk P, Kulig J. Impact of anastomotic leakage on long-term survival after total gastrectomy for carcinoma of the stomach. Br J Surg. 2010;97(7):1035–42.

    Article  CAS  PubMed  Google Scholar 

  11. Tokunaga M, Tanizawa Y, Bando E, et al. Poor survival rate in patients with postoperative intraabdominal infectious complications following curative gastrectomy for gastric cancer. Ann Surg Oncol. 2013;20(5):1575–83.

    Article  PubMed  Google Scholar 

  12. Alldinger I, Schmitt MM, Dreesbach J, et al. Endoscopic treatment of anastomotic leakage after esophagectomy or gastrectomy for carcinoma with self-expanding removable stents. Hepatogastroenterology. 2014;61(129):111–4.

    PubMed  Google Scholar 

  13. Blackmon SH, Santora R, Schwarz P, et al. Utility of removable esophageal covered self-expanding metal stents for leak and fistula management. Ann Thorac Surg. 2010;89(3):931–6 (discussion 936–7).

    Article  PubMed  Google Scholar 

  14. Yoo HM, Lee HH, Shim JH, et al. Negative impact of leakage on survival of patients undergoing curative resection for advanced gastric cancer. J Surg Oncol. 2011;104(7):734–40.

    Article  PubMed  Google Scholar 

  15. McCulloch P, Ward J, Tekkis PP. Mortality and morbidity in gastro-oesophageal cancer surgery: initial results of ASCOT multicentre prospective cohort study. BMJ. 2003;327(7425):1192–7.

    Article  PubMed Central  PubMed  Google Scholar 

  16. Ukleja A. Dumping syndrome: pathophysiology and treatment. Nutr Clin Pract. 2005;20(5):517–25.

    Article  PubMed  Google Scholar 

  17. Mine S, Sano T, Tsutsumi K, et al. Large-scale investigation into dumping syndrome after gastrectomy for gastric cancer. J Am Coll Surg. 2010;211(5):628–36.

    Article  PubMed  Google Scholar 

  18. van der Kleij FG, Vecht J, Lamers CB, et al. Diagnostic value of dumping provocation in patients after gastric surgery. Scand J Gastroenterol. 1996;31(12):1162–6.

    Article  PubMed  Google Scholar 

  19. Li-Ling J, Irving M. Therapeutic value of octreotide for patients with severe dumping syndrome—a review of randomised controlled trials. Postgrad Med J. 2001;77(909):441–2.

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  20. Arts J, Caenepeel P, Bisschops R, et al. Efficacy of the long-acting repeatable formulation of the somatostatin analogue octreotide in postoperative dumping. Clin Gastroenterol Hepatol. 2009;7(4):432–7.

    Article  CAS  PubMed  Google Scholar 

  21. Didden P, Penning C, Masclee AA. Octreotide therapy in dumping syndrome: analysis of long-term results. Aliment Pharmacol Ther. 2006;24(9):1367–75.

    Article  CAS  PubMed  Google Scholar 

  22. Vecht J, Lamers CB, Masclee AA. Long-term results of octreotide-therapy in severe dumping syndrome. Clin Endocrinol (Oxf). 1999;51(5):619–24.

    Article  CAS  Google Scholar 

  23. Sawyers JL, Herrington JL Jr. Superiority of antiperistaltic jejunal segments in management of severe dumping syndrome. Ann Surg. 1973;178(3):311–21.

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  24. Eagon JC, Miedema BW, Kelly KA. Postgastrectomy syndromes. Surg Clin North Am. 1992;72(2):445–65.

    CAS  PubMed  Google Scholar 

  25. Miedema BW, Kelly KA, Camilleri M, et al. Human gastric and jejunal transit and motility after Roux gastrojejunostomy. Gastroenterology. 1992;103(4):1133–43.

    CAS  PubMed  Google Scholar 

  26. Osugi H, Fukuhara K, Takada N, et al. Reconstructive procedure after distal gastrectomy to prevent remnant gastritis. Hepatogastroenterology. 2004;51(58):1215–8.

    CAS  PubMed  Google Scholar 

  27. Csendes A, Burgos AM, Smok G, et al. Latest results (12–21 years) of a prospective randomized study comparing Billroth II and Roux-en-Y anastomosis after a partial gastrectomy plus vagotomy in patients with duodenal ulcers. Ann Surg. 2009;249(2):189–94.

    Article  PubMed  Google Scholar 

  28. Nicolai JJ, Speelman P, Tytgat GN, et al. Comparison of the combination of cholestyramine/alginates with placebo in the treatment of postgastrectomy biliary reflux gastritis. Eur J Clin Pharmacol. 1981;21(3):189–94.

    Article  CAS  PubMed  Google Scholar 

  29. Buch KL, Weinstein WM, Hill TA, et al. Sucralfate therapy in patients with symptoms of alkaline reflux gastritis. A randomized, double-blind study. Am J Med. 1985;79(2C):49–54.

    Article  CAS  PubMed  Google Scholar 

  30. Stefaniwsky AB, Tint GS, Speck J, et al. Ursodeoxycholic acid treatment of bile reflux gastritis. Gastroenterology. 1985;89(5):1000–4.

    CAS  PubMed  Google Scholar 

  31. Davidson ED, Hersh T. The surgical treatment of bile reflux gastritis: a study of 59 patients. Ann Surg. 1980;192(2):175–8.

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  32. Capussotti L, Marucci MM, Arico S, et al. Longterm results of surgical treatment for alkaline reflux gastritis in gastrectomized patients. Am J Gastroenterol. 1984;79(12):924–6.

    CAS  PubMed  Google Scholar 

  33. Tasse D, Ghosn PO, Gagnon M, et al. Alkaline reflux gastritis: Roux-en-Y diversion is effective. Can J Surg. 1982;25(3):337–9.

    CAS  PubMed  Google Scholar 

  34. Bondurant FJ, Maull KI, Nelson HS Jr, et al. Bile reflux gastritis. South Med J. 1987;80(2):161–5.

    Article  CAS  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Surgical Oncology, Division of Surgery, The University of Texas MD Anderson Cancer Center, 1400 Pressler St., Unite #1484, 77030-4009, Houston, TX, USA

    Ryan Day MD & Assoc. Prof. Thomas Aloia MD

  2. Department of Surgical Oncology, Division of Surgery, Infusion Therapy and Mobile Procedure Team, The University of Texas MD Anderson Cancer Center, 1400 Pressler St., Unite #1484, 77030-4009, Houston, TX, USA

    Brian Badgwell MD, MS

Authors
  1. Brian Badgwell MD, MS
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Ryan Day MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Assoc. Prof. Thomas Aloia MD
    View author publications

    You can also search for this author in PubMed Google Scholar

Editor information

Editors and Affiliations

  1. Gastric and Mixed Tumor Service, Memorial Sloan-Kettering Cancer Center, New York, New York, USA

    Vivian E. Strong

Rights and permissions

Reprints and permissions

Copyright information

© 2015 Springer International Publishing Switzerland

About this chapter

Cite this chapter

Badgwell, B., Day, R., Aloia, T. (2015). Managing Early and Late Postoperative Complications Following Gastric Surgery. In: Strong, V. (eds) Gastric Cancer. Springer, Cham. https://doi.org/10.1007/978-3-319-15826-6_17

Download citation

  • DOI: https://doi.org/10.1007/978-3-319-15826-6_17

  • Published:

  • Publisher Name: Springer, Cham

  • Print ISBN: 978-3-319-15825-9

  • Online ISBN: 978-3-319-15826-6

  • eBook Packages: MedicineMedicine (R0)

Publish with us

Policies and ethics

Search

Navigation