Predisposing factors and management of postoperative bleeding after radical gastrectomy for gastric carcinoma
- 224 Downloads
To promote proper management of postoperative bleeding, we investigated the clinical manifestations, predisposing factors, diagnostic approaches, and treatments of bleeding complications after gastric cancer surgery.
Using a prospectively constructed database, we reviewed retrospectively 39 patients who suffered bleeding complications from among a total 1027 patients who underwent surgery for gastric cancer between 2004 and 2008.
Operating time (hazard ratio [HR] 1.842, 95% confidence interval [CI] 1.524–2.367) and body mass index (HR 1.454, 95% CI 1.128–1.792) were significant predisposing factors for postoperative bleeding after gastric cancer surgery. Luminal bleeding occurred in 16 patients: as simple anastomosis site bleeding, treated successfully with conservative or endoscopic treatment, in 13; and as pseudoaneurysmal bleeding in 3, treated successfully with surgery in 2, but resulting in the death of 1. Abdominal bleeding occurred in 23 patients, requiring surgery in 9 and arterial embolization in 1. The most common finding at reoperation was bleeding from the mesocolon surface. The mean hospital stay of patients with postoperative bleeding was 21 (±20) days.
Postoperative bleeding can be managed successfully with a tailored approach, considering its origins and clinical manifestations. Arterial pseudoaneurysms are a rare cause of luminal bleeding, but they can be fatal and should be suspected when extensive luminal bleeding presents after gastric cancer surgery.
Key wordsGastric cancer Postoperative bleeding Morbidity Predisposing factor
Unable to display preview. Download preview PDF.
- 2.Deguili M, Sasako M, Calgaro M, Garino M, Rebecchi F, Mineccia M, et al. Morbidity and mortality after D1 and D2 gastrectomy for cancer: Interim analysis of the Italian Gastric Cancer Study Group (IGCSG) randomized surgical trial. EJSO 2004;30:303–308.Google Scholar
- 3.Sano T, Sasako M, Yamamoto S, Nahimoto A, Kurita A, Hiratsuka M, et al. Gastric cancer surgery: morbidity and mortality results from a prospective randomized controlled trial comparing D2 and extended para-aortic lymphadenectomy-Japan Clinical Oncology Group Study 9501. JCO 2004;22:2767–2773.CrossRefGoogle Scholar
- 7.Uyama I, Oqiwara H, Takahara T, Kikuchi K, Lida S, Jobota T, et al. Spleen and pancreas preserving total gastrectomy with superextended lymphadenectomy including dissection of the paraaortic lymph nodes for gastric cancer. JCOI 1996;63:268–270.Google Scholar
- 13.Piffaretti G, Tozzi M, Carrafiello G, Caronno R, Legana D, Recaldini C, et al. A case of gastroduodenal artery aneurysm in a HIV-positive patient treated by combined percutaneous thrombin injection and endovascular coil embolization. J Cardiovasc Surg (Torino) 2008;49:659–661.Google Scholar