17. Managing Early and Late Postoperative Complications Following Gastric Surgery

Gastric cancer surgery is associated with morbidity rates of 20–30 % and 30-day mortality rates of 4–5 %, based on multi-institutional quality improvement program data. Patients who undergo total gastrectomy have higher morbidity and mortality rates than do patients who undergo subtotal gastrectomy. Resection of adjacent organs also increases the risk of major postoperative complications. Frequently reported complications after gastrectomy include wound and intra-abdominal infection, dehiscence, pulmonary complications, myocardial infarction, thromboembolic complications, and anastomotic leakage. In addition to the standard early postoperative complications of major abdominal surgery, patients undergoing gastric resection are prone to several unique clinical syndromes often referred to as postgastrectomy syndromes. Although these syndromes were more common when peptic ulcer disease was frequently treated with surgery, these syndromes may also manifest in long-term survivors of gastric cancer and therefore are important survivorship issues. Postgastrectomy syndromes and late complications discussed in this chapter include dumping syndrome, afferent limb syndrome, efferent limb syndrome, Roux stasis syndrome, bile reflux gastritis, and postvagotomy diarrhea.