Postoperative Morbidity and Mortality Following D2 Gastrectomy-an Audit of 456 Cases

VD. Surgical and Survival Outcomes of Operable Gastric Cancer-Experience from a Tertiary Care Center in South India

Gastric cancer is one of the leading cancers in Southern India. Data regarding the gastric cancers among the Indian population is sparse. Most patients in our country have locally advanced gastric cancers due to delayed presentation. In this article, we present our data regarding the presentation patterns, epidemiological demographics, surgical outcomes, and survival patterns from a tertiary care center in South India. This is a retrospective analysis of gastric cancer patients who underwent gastrectomy in our institution between January 2015 and November 2021 (n = 102). The data regarding patient characteristics, histopathology, and perioperative outcomes were analysed from medical records. The adjuvant treatment received and survival details were collected from the follow-up records and by telephonic interviews. A total of 128 patients were assessable, 102 patients underwent gastrectomy in a period of 6 years. The median age of presentation was 60 years and males were more commonly affected (70.6%). Most common presentation was pain abdomen followed by gastric outlet obstruction. Adenocarcinoma NOS (93%) was the most common histological type. Most of the Patients had antropyloric growths (79.4%) and subtotal gastrectomy with D2 lymphadenectomy was the most common surgery performed. Majority of the tumors were T4 tumors (55.9%) and nodal metastases were detected in 74% of the specimens. Predominant morbidity was wound infection (6.1%) followed by anastomotic leak (5.9%) with a combined overall morbidity of 16.7% and 30-day mortality of 2.9%. Seventy five (80.5%) patients were able to complete all planned 6 cycles of adjuvant chemotherapy. The median time of survival calculated by Kaplan-Meier method was 23 months with 2-year and 3-year overall survival rates of 31% and 22%, respectively. Lymphovascular invasion (LVSI) and lymph nodal burden were the risk factors associated with recurrences and deaths. The patient characteristics, histological factors, and perioperative outcomes revealed most of our patients presented in locally advanced stages with poor risk histological types and increased nodal burden contributing to the lower survival in our population. Inferior survival outcomes suggest the need to explore perioperative and neoadjuvant chemotherapy options in our population.

The Predictive and Prognostic Factors in Patients with Gastric Cancer Accompanied by Gastric Outlet Obstruction

Purpose

This study is aimed at evaluating the clinicopathological features and prognostic significance of gastric outlet obstruction (GOO) in patients with distal gastric cancer.

Methods

A retrospective review of 1564 individuals with distal gastric cancer from 2002 to 2010 was performed. In total, 157 patients had GOO. The clinicopathological features of the patients with GOO were compared with those of the patients without GOO. A Kaplan-Meier survival analysis and Cox proportional hazard model were used to assess the overall survival.

Results

The patients with distal gastric cancer with GOO generally presented more aggressive pathologic features, a poorer nutritional status, more duodenal infiltration, and peritoneal dissemination than those with cancer without GOO. In the univariate analysis, curability, GOO, age, prealbumin, albumin, hemoglobin (Hb), the tumor size, the macroscopic type, lymph node metastasis, and the depth of invasion had a statistically significant influence on prognosis. The multivariate analysis showed that curability, GOO, the tumor size, lymph node metastasis, and the depth of invasion were independent prognostic factors.

Conclusions

Gastric cancer with GOO exhibits aggressive biological features and has poor outcomes. The multivariate analysis showed that curability, GOO, the tumor size, lymph node metastasis, and the depth of invasion were independent prognostic factors. The gastric outlet status should be considered in the selection of surgical treatment methods for patients with gastric cancer.

Feasibility and Safety of Early Oral Feeding in Patients with Gastric Cancer After Radical Gastrectomy

An enhanced recovery after surgery (ERAS) protocol is useful in patients undergoing colorectal surgery. However, its feasibility for gastric surgery remains unclear. This study aimed to evaluate the feasibility and safety of early oral feeding (EOF) for patients with gastric cancer after radical gastrectomy. The EOF protocol was implemented in 397 patients who underwent radical gastrectomy between 2005 and 2014 at our hospital. The protocol was common in 277 patients after distal gastrectomy (DG) and 120 patients after total gastrectomy (TG). The patients were scheduled to start drinking water in the morning of the first postoperative day and to start thin rice gruel with a liquid nutrition supplement on the second postoperative day. We analyzed the incidence of postoperative complications and surgical outcomes in these patients. Furthermore, we analyzed risk factors for dropout from the EOF protocol. All patients started drinking water, while 26 patients were unable to start eating. The EOF protocol was implemented in 371 patients (93%), and 48 patients stopped eating. Specifically, 227 patients (87%) after DG and 96 patients (88%) after TG followed the EOF protocol perfectly. The incidence of postoperative complications, including anastomotic leakage (n = 0), ileus (n = 22), and pneumonia (n = 11), was 15% and that of clinically significant events (≥ grade 3) was 4.3%. Multivariate analysis showed that the male gender, comorbidities, and intra-operative bleeding are independent risk factors for dropout from the EOF protocol. EOF can be safely implemented in patients after radical gastrectomy.