Abstract
Complication rates and postoperative mortality were studied in 1010 consecutive patients entered into the Norwegian Stomach Cancer Trial. Twenty-eight per cent of the patients had one or more complications (31% of the men and 21% of the women). General complications (pneumonia, thromboembolic, and cardiac) were most frequent. The postoperative mortality rate for resected patients was 8.3% (63 of 763). Complication and mortality rates were highest for proximal resections (52% and 16%) followed by total gastrectomy (38% and 8%), subtotal resection (28% and 10%), and distal resection (19% and 7%). By logistic regression analysis it was found that age, sex, operative procedure, prophylactic antibiotics, and splenectomy were significantly related to postoperative complications. The odds ratio for complication for men versus women was 1.75: for no antibiotics versus antibiotic prophylaxis it was 2.5. Relative to distal resection the odds ratio for complications after subtotal resection was 2.2, for total gastrectomy was 3.9, and for proximal resection was 7.6. Age and sex were the only factors that affected operative mortality. The odds ratio for mortality for men versus women was 2.3. The odds ratio for operative mortality was 2.2 when the age of the patient increased with 10 years.
Full text
PDF![7](https://cdn.ncbi.nlm.nih.gov/pmc/blobs/6c17/1493251/f3f8e41aef57/annsurg00191-0019.png)
![8](https://cdn.ncbi.nlm.nih.gov/pmc/blobs/6c17/1493251/d59211caa498/annsurg00191-0020.png)
![9](https://cdn.ncbi.nlm.nih.gov/pmc/blobs/6c17/1493251/7b6896121aee/annsurg00191-0021.png)
![10](https://cdn.ncbi.nlm.nih.gov/pmc/blobs/6c17/1493251/10148e91d415/annsurg00191-0022.png)
![11](https://cdn.ncbi.nlm.nih.gov/pmc/blobs/6c17/1493251/06e9e4120123/annsurg00191-0023.png)
![12](https://cdn.ncbi.nlm.nih.gov/pmc/blobs/6c17/1493251/ba900f2dbf1b/annsurg00191-0024.png)
![13](https://cdn.ncbi.nlm.nih.gov/pmc/blobs/6c17/1493251/ec24ab5dc2e6/annsurg00191-0025.png)
Selected References
These references are in PubMed. This may not be the complete list of references from this article.
- Adashek K., Sanger J., Longmire W. P., Jr Cancer of the stomach. Review of consecutive ten year intervals. Ann Surg. 1979 Jan;189(1):6–10. doi: 10.1097/00000658-197901000-00002. [DOI] [PMC free article] [PubMed] [Google Scholar]
- Benedetti J. K., Brown M. B. Strategies for the selection of log-linear models. Biometrics. 1978 Dec;34(4):680–686. [PubMed] [Google Scholar]
- Cady B., Ramsden D. A., Stein A., Haggitt R. C. Gastric cancer. Contemporary aspects. Am J Surg. 1977 Apr;133(4):423–429. doi: 10.1016/0002-9610(77)90126-x. [DOI] [PubMed] [Google Scholar]
- Cole W. R., Petit R., Bernard H. R. Factors affecting incidence of anastomotic leak following esophagogastrectomy. An analysis. Ann Thorac Surg. 1968 Oct;6(4):396–400. doi: 10.1016/s0003-4975(10)66043-2. [DOI] [PubMed] [Google Scholar]
- Cupples L. A., Heeren T., Schatzkin A., Colton T. Multiple testing of hypotheses in comparing two groups. Ann Intern Med. 1984 Jan;100(1):122–129. doi: 10.7326/0003-4819-100-1-122. [DOI] [PubMed] [Google Scholar]
- Fujimaki M., Soga J., Wada K., Tani H., Aizawa O. Total gastrectomy for gastric cancer. Clinical considerations on 431 cases. Cancer. 1972 Sep;30(3):660–664. doi: 10.1002/1097-0142(197209)30:3<660::aid-cncr2820300313>3.0.co;2-4. [DOI] [PubMed] [Google Scholar]
- Gall F. P., Hermanek P. New aspects in the surgical treatment of gastric carcinoma--a comparative study of 1636 patients operated on between 1969 and 1982. Eur J Surg Oncol. 1985 Sep;11(3):219–225. [PubMed] [Google Scholar]
- Gennari L., Bozzetti F., Bonfanti G., Morabito A., Bufalino R., Doci R., Andreola S. Subtotal versus total gastrectomy for cancer of the lower two-thirds of the stomach: a new approach to an old problem. Br J Surg. 1986 Jul;73(7):534–538. doi: 10.1002/bjs.1800730706. [DOI] [PubMed] [Google Scholar]
- Gilbertsen V. A. Results of treatment of stomach cancer. An appraisal of efforts for more extensive surgery and a rort of 1,983 cases. Cancer. 1969 Jun;23(6):1305–1308. doi: 10.1002/1097-0142(196906)23:6<1305::aid-cncr2820230610>3.0.co;2-0. [DOI] [PubMed] [Google Scholar]
- Hermreck A. S., Crawford D. G. The esophageal anastomotic leak. Am J Surg. 1976 Dec;132(6):794–798. doi: 10.1016/0002-9610(76)90461-x. [DOI] [PubMed] [Google Scholar]
- Inberg M. V., Heinonen R., Rantakokko V., Viikari S. J. Surgical treatment of gastric carcinoma: a regional study of 2,590 patients over a 27-year period. Arch Surg. 1975 Jun;110(6):703–707. doi: 10.1001/archsurg.1975.01360120021003. [DOI] [PubMed] [Google Scholar]
- Inberg M. V., Linna M. I., Scheinin T. M., Vänttinen E. Aanastomotic leakage after excision of esophageal and high gastric carcinoma. Am J Surg. 1971 Oct;122(4):540–544. doi: 10.1016/0002-9610(71)90484-3. [DOI] [PubMed] [Google Scholar]
- Kennedy B. J. Staging of gastric cancer. Semin Oncol. 1985 Mar;12(1):19–20. [PubMed] [Google Scholar]
- Longmire W. P., Jr Gastric carcinoma: is radical gastrectomy worth while? Ann R Coll Surg Engl. 1980 Jan;62(1):25–30. [PMC free article] [PubMed] [Google Scholar]
- Lundh G., Burn J. I., Kolig G., Richard C. A., Thomson J. W., van Elk P. J., Oszacki J. A co-operative international study of gastric cancer (under the auspices of the International Federation of Surgical Colleges). Ann R Coll Surg Engl. 1974 May;54(5):219–228. [PMC free article] [PubMed] [Google Scholar]
- MARSHALL S. F. Total versus radical partial resection for cancer of the stomach. Surg Gynecol Obstet. 1957 Apr;104(4):497–498. [PubMed] [Google Scholar]
- Maillard J. N., Launois B., Lellouch J., Lortat-Jacob J. L., de Lagausie Cause of leakage at the site of anastomosis after esophagogastric resection for carcinoma. Surg Gynecol Obstet. 1969 Nov;129(5):1014–1018. [PubMed] [Google Scholar]
- McNEER G., PACK G. T. Postoperative mortality after total gastrectomy. Cancer. 1954 Sep;7(5):1010–1015. doi: 10.1002/1097-0142(195409)7:5<1010::aid-cncr2820070526>3.0.co;2-0. [DOI] [PubMed] [Google Scholar]
- Miwa H., Orita K. Splenectomy combined with gastrectomy and immunotherapy for advanced gastric cancer. Acta Med Okayama. 1983 Jun;37(3):251–258. doi: 10.18926/AMO/32439. [DOI] [PubMed] [Google Scholar]
- Mullen J. L., Gertner M. H., Buzby G. P., Goodhart G. L., Rosato E. F. Implications of malnutrition in the surgical patient. Arch Surg. 1979 Feb;114(2):121–125. doi: 10.1001/archsurg.1979.01370260011001. [DOI] [PubMed] [Google Scholar]
- Papachristou D. N., Fortner J. G. Anastomotic failure complicating total gastrectomy and esophagogastrectomy for cancer of the stomach. Am J Surg. 1979 Sep;138(3):399–402. doi: 10.1016/0002-9610(79)90271-x. [DOI] [PubMed] [Google Scholar]
- Shiu M. H., Papacristou D. N., Kosloff C., Eliopoulos G. Selection of operative procedure for adenocarcinoma of the midstomach. Twenty years' experience with implications for future treatment strategy. Ann Surg. 1980 Dec;192(6):730–737. doi: 10.1097/00000658-198012000-00007. [DOI] [PMC free article] [PubMed] [Google Scholar]
- Sugimachi K., Kodama Y., Kumashiro R., Kanematsu T., Noda S., Inokuchi K. Critical evaluation of prophylactic splenectomy in total gastrectomy for the stomach cancer. Gan. 1980 Oct;71(5):704–709. [PubMed] [Google Scholar]
- Søreide O., Lillestøl J., Viste A., Bjerkeset T. Factors influencing survival in patients with cancer of the stomach. A multivariate analysis. Acta Chir Scand. 1982;148(4):367–372. [PubMed] [Google Scholar]
- Yamada E., Miyaishi S., Nakazato H., Kato K., Kito T., Takagi H., Yasue M., Kato T., Morimoto T., Yamauchi M. The surgical treatment of cancer of the stomach. Int Surg. 1980 Sep-Oct;65(5):387–399. [PubMed] [Google Scholar]