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Morbidity and Mortality Associated with Gastrectomy for Gastric Cancer

  • Gastrointestinal Oncology
  • Published:
Annals of Surgical Oncology Aims and scope Submit manuscript

Abstract

Background

Surgery alone is often inadequate for advanced-stage gastric cancer. Surgical complications may delay adjuvant therapy. Understanding these complications is needed for multidisciplinary planning.

Material and Methods

The American College of Surgeons National Surgical Quality Improvement Program (ACS NSQIP) database was queried for patients who underwent gastrectomy for malignancy (ICD-9 code 151.x) from 2005 to 2010. Thirty-day mortality and morbidity were evaluated.

Results

Overall, 2,580 patients underwent gastrectomy for malignancy, divided as total gastrectomy 999 (38.7 %) and partial gastrectomy 1,581 (61.3 %). Overall, serious morbidity occurred in 23.6 %, and the 30-day mortality was 4.1 %. Patients receiving a total gastrectomy were younger and healthier than those receiving a partial gastrectomy for the following measured criteria: age, diabetes, chronic obstructive pulmonary disease and hypertension. Serious morbidity and mortality were significantly higher in the total gastrectomy group than the partial gastrectomy group (29.3 vs. 19.9 %, p < 0.001; and 5.4 vs. 3.4 %, p < 0.015, respectively). The inclusion of additional procedures increased the risk of mortality for the following: splenectomy (odds ratio [OR] 2.8; p < 0.001), pancreatectomy (OR 3.5; p = 0.001), colectomy (OR 3.6; p < 0.001), enterectomy (OR 2.7; p = 0.030), esophagectomy (OR 3.5; p = 0.035). Abdominal lymphadenectomy was not associated with increased morbidity (OR 1.1; p = 0.41); rather, it was associated with decreased mortality (OR 0.468; p = 0.028).

Conclusions

Gastrectomy for cancer as currently practiced carries significant morbidity and mortality. Inclusion of additional major procedures increases these risks. The addition of lymphadenectomy was not associated with increased morbidity or mortality. Strategies are needed to optimize surgical outcomes to ensure delivery of multimodality therapy for advanced-stage disease.

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Authors and Affiliations

  1. Department of Surgical Oncology, Roswell Park Cancer Institute, Buffalo, NY, USA

    Wesley A. Papenfuss MD, FACS, Moshim Kukar MD, Jacqueline Oxenberg DO, Steven Nurkin MD, MS & Neal W. Wilkinson MD, FACS

  2. Department of Biostatistics, Roswell Park Cancer Institute, Buffalo, NY, USA

    Kristopher Attwood MA, PhD

  3. Department of Medicine, Roswell Park Cancer Institute, Buffalo, NY, USA

    Usha Malhotra MD

Authors
  1. Wesley A. Papenfuss MD, FACS
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  2. Moshim Kukar MD
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  3. Jacqueline Oxenberg DO
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  4. Kristopher Attwood MA, PhD
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  5. Steven Nurkin MD, MS
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  6. Usha Malhotra MD
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  7. Neal W. Wilkinson MD, FACS
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Corresponding author

Correspondence to Neal W. Wilkinson MD, FACS.

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Papenfuss, W.A., Kukar, M., Oxenberg, J. et al. Morbidity and Mortality Associated with Gastrectomy for Gastric Cancer. Ann Surg Oncol 21, 3008–3014 (2014). https://doi.org/10.1245/s10434-014-3664-z

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  • DOI: https://doi.org/10.1245/s10434-014-3664-z

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