Updates in Surgery

, Volume 65, Issue 2, pp 95–101 | Cite as

Bursectomy in gastric cancer surgery: surgical technique and operative safety

  • Konstantinos Blouhos
  • Konstantinos A. Boulas
  • Anestis Hatzigeorgiadis
Original Article

Abstract

Although there is little evidence that bursectomy has clinical benefit, its continuing practice imposes evaluation of bursectomy-related adverse effects, especially pancreatic fistula and intestinal obstruction. The aims of this study were to provide a detailed description of the technique of bursectomy as standardized by the authors and determine if extended surgery for gastric cancer with additional bursectomy can be performed safely in Western population. A total of 72 consecutive patients of median age 76.4 years and mean ASA score grade 2.1, who submitted to D2 or D2+ gastrectomy with additional bursectomy for gastric adenocarcinoma, were prospectively studied. Bursectomy was associated with a median additional operative time of 41 min and a median additional blood loss of 65 ml. The post-operative morbidity rate was 19.4 %. Among various adverse events, pancreatic fistula was observed in three patients (4.2 %) and intestinal obstruction was observed in eight patients (11.1 %) including two cases of delayed gastric emptying, one case of afferent loop syndrome, one case of early postoperative adhesions and four cases of prolonged postoperative ileus. The in-hospital mortality rate was 1.4 %. D2 or D2+ gastrectomy with additional bursectomy can be safely performed in Western patients. Although the incidence of pancreatic fistula that we reported was low, the incidence of bursectomy-related intestinal obstruction was high and should always be kept in mind when performing extended surgery for gastric cancer.

Keywords

Gastrectomy D2+ lymphadenectomy Bursectomy Pancreatic fistula Intestinal obstruction 

Notes

Conflict of interest

The authors declare that they have no conflict of interest.

References

  1. 1.
    Hundahl SA (2012) The potential value of bursectomy in operations for trans-serosal gastric adenocarcinoma. Gastric Cancer 15:3–4PubMedCrossRefGoogle Scholar
  2. 2.
    Fujita J, Kurokawa Y, Takiguchi S, Doki Y (2012) Authors’ reply: should we inherit bursectomy or discard it? Gastric Cancer 15:226–227PubMedCrossRefGoogle Scholar
  3. 3.
    Japanese Gastric Cancer Association (2011) Japanese gastric cancer treatment guidelines (ver. 3). Gastric Cancer 14:113–123CrossRefGoogle Scholar
  4. 4.
    Kurokawa Y, Fujiwara Y, Takiguchi S et al (2011) Randomized controlled trial of omental bursectomy for resectable cT2-3 gastric cancer. J Clin Oncol (Meeting Abstracts) 29(4_suppl):72Google Scholar
  5. 5.
    Kayaalp C, Piskin T, Olmez A (2012) Complications of bursectomy after radical gastrectomy for gastric cancer. World J Surg 36:229PubMedCrossRefGoogle Scholar
  6. 6.
    Japanese Gastric Cancer Association (2011) Japanese classification of gastric carcinoma: 3rd English edition. Gastric Cancer 201:101–112CrossRefGoogle Scholar
  7. 7.
    Bassi C, Dervenis C, Butturini G et al (2005) Postoperative pancreatic fistula: an international study group (ISGPF) definition. Surgery 138:8–13PubMedCrossRefGoogle Scholar
  8. 8.
    Dindo D, Demartines N, Clavien PA (2004) Classification of surgical complications: a new proposal with evaluation in a cohort of 6336 patients and results of a survey. Ann Surg 240:205–213PubMedCrossRefGoogle Scholar
  9. 9.
    Ludwig KA (2007) Sphincter-sparing resection for rectal cancer. Clin Colon Rectal Surg 20:203–212PubMedCrossRefGoogle Scholar
  10. 10.
    Heald RJ (1988) The ‘Holy Plane’ of rectal surgery. J R Soc Med 81:503–508PubMedGoogle Scholar
  11. 11.
    Skandalakis JE, Colborn GL, Weidman TA et al (2004) Skandalakis’ surgical anatomy. AccessSurgery. http://accesssurgery.com/resourceToc.aspx?resourceID=203. Accessed 16 June 2012
  12. 12.
    Skandalakis JE, Colborn GL, Weidman TA et al (2004) Skandalakis’ surgical anatomy. AccessSurgery. http://accesssurgery.com/content.aspx?aid=70499. Accessed 16 June 2012
  13. 13.
    Imamura H, Kurokawa Y, Kawada J et al (2011) Influence of bursectomy on operative morbidity and mortality after radical gastrectomy for gastric cancer: results of a randomized controlled trial. World J Surg 35:625–630PubMedCrossRefGoogle Scholar
  14. 14.
    Fujita J, Kurokawa Y, Sugimoto T et al (2012) Survival benefit of bursectomy in patients with resectable gastric cancer: interim analysis results of a randomized controlled trial. Gastric Cancer 15:42–48PubMedCrossRefGoogle Scholar
  15. 15.
    Kochi M, Fujii M, Kanamori N et al (2012) D2 Gastrectomy with versus without bursectomy for gastric cancer. Am J Clin Oncol 13 [Epub ahead of print]Google Scholar
  16. 16.
    Herbella FA, Tineli AC, Wilson JL Jr, Del Grande JC (2008) Gastrectomy and lymphadenectomy for gastric cancer: is the pancreas safe? J Gastrointest Surg 12:1912–1914PubMedCrossRefGoogle Scholar
  17. 17.
    Kayaalp C, Olmez A, Piskin T (2011) Prophylactic bursectomy at radical gastrectomy for gastric cancer. Gastric Cancer 14:399–400PubMedCrossRefGoogle Scholar
  18. 18.
    Yoon SS, Yang HK (2009) Lymphadenectomy for gastric adenocarcinoma: should west meet east? Oncologist 14:871–882PubMedCrossRefGoogle Scholar
  19. 19.
    Lamb P, Sivashanmugam T, White M, Irving M, Wayman J, Raimes S (2008) Gastric cancer surgery–a balance of risk and radicality. Ann R Coll Surg Engl 90:235–242PubMedCrossRefGoogle Scholar
  20. 20.
    Kodera Y, Ito S, Yamamura Y et al (2004) Obesity and outcome of distal gastrectomy with D2 lymphadenectomy for carcinoma. Hepatogastroenterology 51:1225–1228PubMedGoogle Scholar
  21. 21.
    Park DJ, Lee HJ, Kim HH, Yang HK, Lee KU, Choe KJ (2005) Predictors of operative morbidity and mortality in gastric cancer surgery. Br J Surg 92:1099–1102PubMedCrossRefGoogle Scholar
  22. 22.
    Yoshikawa T, Tsuburaya A, Kobayashi O et al (2004) Is bursectomy necessary for patients with gastric cancer invading the serosa? Hepatogastroenterology 51:1524–1526PubMedGoogle Scholar
  23. 23.
    Japanese Gastric Cancer Association Registration Committee, Maruyama K, Kaminishi M et al (2006) Gastric cancer treated in 1991 in Japan: data analysis of nationwide registry. Gastric Cancer 9:51–66PubMedCrossRefGoogle Scholar
  24. 24.
    Lee JH, Kim KM, Cheong JH, Noh SH (2012) Current management and future strategies of gastric cancer. Yonsei Med J 53:248–257PubMedCrossRefGoogle Scholar

Copyright information

© Springer-Verlag Italia 2013

Authors and Affiliations

  • Konstantinos Blouhos
    • 1
  • Konstantinos A. Boulas
    • 1
  • Anestis Hatzigeorgiadis
    • 1
  1. 1.Department of General SurgeryGeneral Hospital of DramaDramaGreece

Personalised recommendations