Various complications have Various complications have been noted after total gastrectomy for stomach cancer. Among them, leakage, stenosis, reflux esophagitis and malnutrition were great problems. Our retrospective study was conducted to
determine
the
complication rate along the various operative procedures. We have analyzed the 148 cases of stomach cancer which was operated with the total gastrectomy during the 7 years period from February, 1985 to February, 1992.
@ES The results are as follow:
@EN 1) During 7 years, we performed gastrectomy in 675 patients of gastric cancer. Among them 159 cases(23.6%) underwent total gastrectomy.
2) Total gastrectomy with splenectomy was performed in 67 cases(45.3%), total gastrectomy alone in 43 cases(29.1%), and total gastrectomy with splenectomy and distal pancreatectomy in 29 cases(19.8%). Reconstruction was performed with Roux-en-Y
method
in 88 cases(59.5%) and Loop and Braun method in 60 cases(40.5%). We used autosuture in 136 cases(93.9%) for anastomosis.
3) Early complications were noted in 36 cases(24.3%); pleural effusion in 17 cases(11.5%), anastomotic leakage 7 cases(4.7%), wound infection 7 cases(4.7%), and subphrenic abscess 3 cases(2.0%). Anastomotic leakage was more common in manual
anastomosis
(16.7%) than autosuture(3.7%).
4) In late complications, anastomotic stenosis was noted in 11.1% of the manual group and 10.1% of the autosuture group(EEA 25mm 9.8%, EEA 28mm 11.4%, EEA 31mm 0%). Severe reflux esophagitis was noted in 5.6%. More high incidence was noted in
Loop
and
Braun method (11.6%) than Roux-en-Y(1.5%).
5) In nutritional assessment of postoperative 1 year, body weight was reduced in 70.4%(76/108), hemoglobin was reduced in 63.9%(69/108), and albumin was reduced in 55.6%(60/108).
6) Operative mortality rate was 2.0%. The main causes of death were sepsis and multiple organ failure due to anastomotic leakage.
Our experience confirms that the appropriate large size autosuture anastomosis with Roux-en-Y reconstruction will reduce the incidence of operative mortality and complications in total gastrectomy.
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