The Risk of Combined Organ Resection in Radical Gastrectomy

Background: Combined organ resection was not rare operation in gastric cancer surgery. Cholecystectomy and splenectomy were most frequently operated in gastrectomy. Additionally, the development of the laparoscopic surgery offers more chance to operate with them. We investigated the risk of the combined organ resection in gastric cancer surgery.
Materials and Methods: The clinical data on 401 consecutive patients who underwent radical gastrectomy with D2 level lymph node dissection for gastric cancer at Gyeongsang National University Hospital between January 2005 to December 2007 were analyzed. We retrospectively collected the data regarding age, sex, length of hospital stay, underlying diseases, BMI, ASA score, op time, operative methods (open or laparoscopy, reconstruction and combined resection) and complications. We investigated the risk of combined organ resection in radical gastrectomy.
Results: There were a total of 401 patients, and their mean age was 61.8 years. The ratio of males to females was 2.01 to 1. Laparoscopy assisted gastrectomy was performed in 262 cases, and open gastrectomy was in 139 cases. For operation methods, subtotal gastrectomy was performed in 70.5%, total gastrectomy in 21.4 %, proximal gastrectomy in 5.7%, and wedge resection in 2.2 %.
For stages, stage I was 69.8%, stage II was 13.5%, stage III was 12.7% and stage IV was 4%. The overall number of combined organ resection was 70 patients. The most common organ was gallbladder (36cases), followed by spleen (18cases), colon (9 cases), liver (4), small bowel (4), appendix (4), pancreas (3).
The mean operation times were different in statically significant in open groups: no combined resection groups (275min) and combined resection groups (315min) (p=0.02). There were different too in laparoscopic groups: no combined resection groups (395min) and combined resection groups (445min (p=0.00)). However, there had not statistically difference in mean hospital stays.
The combined organ resection were significantly related to surgical complication ((p=0.043). However, it was not affected either open surgery (10/36) or laparoscopy assisted operation (9/34) (p=0.55). It affected by what kind of organs were resected. In cases of spleen resection, it was significantly related to surgical complications (9/18, p=0.002). The colon resections (4/9), pancreatic resections (2/3) were increased better than mean complication rate but it were not statistically significant. The cholecystectomy, liver resection or appendectomy was not statistically significant.
Conclusion: The combined organ resection was significantly related to surgical complication in radical gastrectomy. However, it was not affected either open surgery or laparoscopy assisted operation. It affected by what kind of organs were resected (spleen).


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Program Number: P334

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