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Morbidity and Mortality of Total Gastrectomy: a Comprehensive Analysis of 90-Day Outcomes

  • 2018 SSAT Poster Presentation
  • Published:
Journal of Gastrointestinal Surgery Aims and scope

Abstract

Background

Total gastrectomy (TG) is a complex procedure that carries a high risk of morbidity and mortality and in which patients may experience post-operative sequelae well past the standard 30-day follow-up period. Large studies from high-volume centers with detailed 90-day follow-up data are needed to provide benchmarks for high-quality care for this complex procedure.

Methods

Single-institution, retrospective review of a comprehensive gastric cancer database of 148 patients undergoing curative intent TG from 2000 to 2017. Clinicopathologic and treatment factors were analyzed for their impact on 90-day outcomes.

Results

The median age of the cohort was 66 years, and 61% were male. Neoadjuvant chemotherapy and radiation therapy were delivered to 32% and 11% of patients, respectively. Open and laparoscopic TG were performed in 93% (n = 137) and 7% (n = 11) of patients, respectively. Extended lymphadenectomy, pancreatectomy, and splenectomy were performed in 37%, 4.7%, and 19% of patients, respectively. The 30- and 90-day mortality rates were 2.0% and 3.4%, respectively. At least one 90-day complication was experienced by 43.9% (n = 65) of patients, and 14% (n = 21) experienced a Clavien–Dindo grade 3 or 4 complication. Anastomotic leak occurred in 5.4% (n = 8) of patients, half of which required an invasive intervention. Median length of stay was 8 days. The readmission rate was 22%, and most readmissions were due to dehydration and/or nutritional compromise.

Conclusions

This study defines 30- and 90-day post-operative outcomes after total gastrectomy in a high-volume center. These outcomes data are critical to the improvement of the informed consent process and as benchmarks for future quality improvement initiatives.

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Authors and Affiliations

  1. Department of Surgery, Massachusetts General Hospital, 55 Fruit Street, YAW-7926, Boston, MA, 02114, USA

    Selena S. Li, Christina L. Costantino & John T. Mullen

  2. Harvard Medical School, Boston, MA, USA

    Selena S. Li, Christina L. Costantino & John T. Mullen

Authors
  1. Selena S. Li
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  2. Christina L. Costantino
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  3. John T. Mullen
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Contributions

All three authors (Li, Costantino, and Mullen) made substantial contributions to the conception and design of this study, including acquisition, analysis, and interpretation of the data. All three authors drafted and critically revised the manuscript and have granted final approval to this final version to be published. All three authors agree to be accountable for all aspects of this manuscript in ensuring that questions related to the accuracy or integrity of any part of it are appropriately investigated and resolved.

Corresponding author

Correspondence to John T. Mullen.

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Presented as a poster at Digestive Disease Week, June 2–5, 2018, Washington, DC.

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Li, S.S., Costantino, C.L. & Mullen, J.T. Morbidity and Mortality of Total Gastrectomy: a Comprehensive Analysis of 90-Day Outcomes. J Gastrointest Surg 23, 1340–1348 (2019). https://doi.org/10.1007/s11605-019-04228-7

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  • DOI: https://doi.org/10.1007/s11605-019-04228-7

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