Surgical Outcomes and Early Postoperative Complications in Locally Advanced Gastric Cancer

OBJECTIVE: In Western world, 60 to 65% of the gastric cancer cases are in locally advanced stage at the time of diagnosis and in these patients, extended resections may increase the risk of complications. The aim of this study was to investigate the resectability rates and to determine early morbidity and mortality rates after resections for locally advanced gastric cancer.
METHODS: Consecutive non-metastatic locally advanced gastric cancer patients treated between October 2002 and September 2006 were included in this retrospective exploratory analyses study.
RESULTS: One hundred and ten patients (49.8%) had additional organ resection due to adjacent organ involvement. R0 resection was achieved in 181 patients (82%), R1 resection in 29 patients (13%), and R2 resection in 11 patients (5%). The morbidity and mortality rates of the all series were 21,7% and 4.5% respectively. More than two additional organ resections (p=0.001), eryhtrocyte transfusions of more than 2 units (p=0.001) and low total protein levels (p=0.008) were determined as the parameters which increase complication rates according to multivariate analysis. The parameters which increase mortality rates were as follows; having two or more additional organ resections (p=0.001), cardiovascular and respiratory comorbidities (p=0.002) and total gastrectomy (p=0.028).
CONCLUSION: Additional organ resection rates of the patient with locally advanced gastric cancers that not given neo-adjuvant treatment is high and this occurance increases the morbidity and mortality rates. Altough total gastrectomy has been found to be a factor for increased mortality in locally advanced gastric cancer, D2 dissection is safe for these patients

Lokal Ýleri Evre Mide Kanserinde Cerrahi Sonuçlar ve Erken Postoperatif Komplikasyonlar

AMAÇ: Batý ülkelerinde saptanan mide kanserlerinin %60-65’i taný anýnda lokal ileri evrededirler. Bu hastalara uygulanan geniþletilmiþ rezeksiyonlar komplikasyon riskini arttýrabilir. Bu çalýþmanýn amacý lokal ileri evre mide kanserlerinde rezektabilite, erken dönem mortalite ve morbidite oranlarýný saptamaktýr.
YÖNTEMLER: Ocak 2002 ile Eylül 2006 tarihleri arasýnda rezeksiyon uygulanan non-metastatik, lokal ileri evre mide kanserli hastalarýmýz geriye dönük olarak incelendi.
BULGULAR: Komþu organ invazyonu nedeni ile 110 hastaya (%49.8) ek organ rezeksiyonu uygulanmýþtý. Yüzseksen bir hastaya (%82) R0, 29 hastaya (%13) R1 ve 11 hastaya (%5) R2 rezeksiyon yapýlabilmiþti. Tüm serinin morbidite ve mortalite oranlarý sýrasýyla %21.7 ve % 4.5 olarak bulundu. Ýkiden fazla ek organ rezeksiyonu (p=0.001), 2 üniteden fazla kan transfüzyonu (p=0.001) ve düþük protein seviyeleri (p=0.008) multivaryant analizlerde komplikasyon oranlarýný arttýran parametreler olarak saptandý. Ýki veya daha fazla ek organ rezeksiyonu (p=0.001), kardiyovasküler ve respiratuar komorbidite (p=0.002) ve total gastrektomi uygulanmasý (p=0.028) mortaliteyi arttýran faktörler olarak bulundu.
SONUÇ: Neo-adjuvan tedavi uygulanmayan lokal ileri evre mide kanserli hastalarda ek organ rezeksiyonu oranlarý yüksektir ve bu durum morbidite ve mortalite oranlarýný arttýrýr. Total gastrektomi mortaliteyi arttýran bir faktör olarak belirlenmiþ ancak D2 diseksiyonun bu hastalarda güvenle uygulanabileceði sonucuna varýlmýþtýr.