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Complications Following D3 Gastrectomy: Post Hoc Analysis of a Randomized Trial

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Abstract

Introduction

A single institutional surgical trial for gastric cancer had demonstrated increased morbidity but not mortality. This report analyzes risk factors affecting morbidity.

Methods

Risk factors for morbidity in 221 patients treated with curative intent were evaluated in a prospective randomized trial comparing D1 and D3 surgery for curable gastric cancer.

Results

The surgeon’s experience after 25 nodal dissections had no influence on surgical or overall complications, nor did the patients’ co-morbidity (e.g., respiratory system disease, cardiac disease, diabetes mellitus). Distal pancreatectomy negatively affected surgical morbidity [relative risk (RR) 6.21, 95% confidence interval (CI) 1.869–20.626] and overall morbidity (RR 5.50, 95% CI 1.671–18.082). All of the patients with a distal pancreatectomy underwent concomitant splenectomy. Multivariate analysis found splenectomy and nodal dissection to be the only two independent risk factors adversely affecting operative morbidity. The RR of splenectomy for surgical complications was 4.19 (95% CI 1.327–13.208), and for overall complications it was 3.88 (95% CI 1.259–11.973). The RR of nodal dissection for surgical complications was 2.51 (95% CI 1.336–4.730), and for overall complications it was 1.93 (95% CI 1.149–3.255).

Conclusions

Splenectomy (with or without pancreatectomy) and nodal dissection are risk factors for operative morbidity but not mortality.

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Acknowledgements

The authors thank Hui-Tzu Yu and Yurh-Ling Ho of the data center at the National Health Research Institutes and research nurse Li-Ting Shia for assistance with data collection and processing. This study was supported by the Division of Cancer Research, National Health Research Institutes, Taiwan.

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Authors and Affiliations

  1. Department of Surgery, Taipei Veterans General Hospital, Shi Pai Road, Taipei, 112, Taiwan

    Chew-Wun Wu MD, Su-shun Lo MD, Mao-Chin Hsieh MD, Jen-Hao Chen MD & Wing-Yiu Lui MD

  2. National Yang-Ming University, 155 Li Nong Street, Section 2, Shih Pai Road, Taipei, Taiwan

    Chew-Wun Wu MD, Su-shun Lo MD, Mao-Chin Hsieh MD, Jen-Hao Chen MD & Wing-Yiu Lui MD

  3. President’s Laboratory, National Health Research Institutes, 3 Yuanqu Street, Taipei, Taiwan

    I-Shou Chang PhD

  4. Division of Cancer Research, National Health Research Institutes, 3 Yuanqu Street, Taipei, Taiwan

    Jacqueline Whang-Peng MD

Authors
  1. Chew-Wun Wu MD
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  2. I-Shou Chang PhD
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  3. Su-shun Lo MD
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  4. Mao-Chin Hsieh MD
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  5. Jen-Hao Chen MD
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  6. Wing-Yiu Lui MD
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  7. Jacqueline Whang-Peng MD
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Corresponding author

Correspondence to Chew-Wun Wu MD.

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Wu, CW., Chang, IS., Lo, Ss. et al. Complications Following D3 Gastrectomy: Post Hoc Analysis of a Randomized Trial. World J. Surg. 30, 12–16 (2006). https://doi.org/10.1007/s00268-005-7951-5

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  • DOI: https://doi.org/10.1007/s00268-005-7951-5

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