Gastric cancer surgery in cirrhotic patients: Result of gastrectomy with D2 lymph node dissection

Jun Ho Lee, Junuk Kim, Jae Ho Cheong, WooJin Hyung, Seung Ho Choi, Sung Hoon Noh

Research output: Contribution to journalArticle

20 Citations (Scopus)

Abstract

Aim:To explore the feasibility of performing gastrectomy with D2 lymphadenectomy in gastric cancer patients with liver cirrhosis. Methods: A total of 7 178 patients were admitted with a diagnosis of liver cirrhosis from January 1993 to December 2003. We reviewed the records of 142 patients who were diagnosed with liver cirrhosis and gastric adenocarcinoma during the same period. Gastrectomy with D2 lymph node dissection for carcinoma of the stomach was performed in 94 patients with histologically proven hepatic cirrhosis. Results: All but 12 patients were classified as Child's class A. Only 35 patients (37.2%) were diagnosed with cirrhosis before operation. Seventy-three patients underwent a subtotal gastrectomy (77.7%) and 21 patients (22.3%) underwent a total gastrectomy, each with D2 or more lymph node dissection. Two patients (3.8%) who had prophylactic intra-operative drain placement, died of postoperative complications from hepatorenal failure with intractable ascites. Thirty-seven patients (39.4%) experienced postoperative complications. The extent of gastric resection did not influence the morbidity whereas serum aspartate aminotransferase level (P = 0.011) and transfusion did (P = 0.008). The most common postoperative complication was ascites (13.9%) followed by wound infection (10.6%). Conclusion: We concluded that the presence of compensated cirrhosis, i.e. Child class A, is not a contra indication against gastrectomy with D2 or more lymph node dissection, when curative resection for gastric cancer is possible. Hepatic reserve and meticulous hemostasis are the likely determinants of operative prognosis.

Original languageEnglish
Pages (from-to)4623-4627
Number of pages5
JournalWorld Journal of Gastroenterology
Volume11
Issue number30
DOIs
Publication statusPublished - 2005 Aug 14

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Gastrectomy
Lymph Node Excision
Stomach Neoplasms
Liver Cirrhosis
Stomach
Ascites
Fibrosis
Wound Infection
Aspartate Aminotransferases
Hemostasis
Adenocarcinoma
Morbidity
Carcinoma
Liver

All Science Journal Classification (ASJC) codes

  • Gastroenterology

Cite this

Lee, Jun Ho ; Kim, Junuk ; Cheong, Jae Ho ; Hyung, WooJin ; Choi, Seung Ho ; Noh, Sung Hoon. / Gastric cancer surgery in cirrhotic patients : Result of gastrectomy with D2 lymph node dissection. In: World Journal of Gastroenterology. 2005 ; Vol. 11, No. 30. pp. 4623-4627.
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abstract = "Aim:To explore the feasibility of performing gastrectomy with D2 lymphadenectomy in gastric cancer patients with liver cirrhosis. Methods: A total of 7 178 patients were admitted with a diagnosis of liver cirrhosis from January 1993 to December 2003. We reviewed the records of 142 patients who were diagnosed with liver cirrhosis and gastric adenocarcinoma during the same period. Gastrectomy with D2 lymph node dissection for carcinoma of the stomach was performed in 94 patients with histologically proven hepatic cirrhosis. Results: All but 12 patients were classified as Child's class A. Only 35 patients (37.2{\%}) were diagnosed with cirrhosis before operation. Seventy-three patients underwent a subtotal gastrectomy (77.7{\%}) and 21 patients (22.3{\%}) underwent a total gastrectomy, each with D2 or more lymph node dissection. Two patients (3.8{\%}) who had prophylactic intra-operative drain placement, died of postoperative complications from hepatorenal failure with intractable ascites. Thirty-seven patients (39.4{\%}) experienced postoperative complications. The extent of gastric resection did not influence the morbidity whereas serum aspartate aminotransferase level (P = 0.011) and transfusion did (P = 0.008). The most common postoperative complication was ascites (13.9{\%}) followed by wound infection (10.6{\%}). Conclusion: We concluded that the presence of compensated cirrhosis, i.e. Child class A, is not a contra indication against gastrectomy with D2 or more lymph node dissection, when curative resection for gastric cancer is possible. Hepatic reserve and meticulous hemostasis are the likely determinants of operative prognosis.",
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Gastric cancer surgery in cirrhotic patients : Result of gastrectomy with D2 lymph node dissection. / Lee, Jun Ho; Kim, Junuk; Cheong, Jae Ho; Hyung, WooJin; Choi, Seung Ho; Noh, Sung Hoon.

In: World Journal of Gastroenterology, Vol. 11, No. 30, 14.08.2005, p. 4623-4627.

Research output: Contribution to journalArticle

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AU - Lee, Jun Ho

AU - Kim, Junuk

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AU - Choi, Seung Ho

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N2 - Aim:To explore the feasibility of performing gastrectomy with D2 lymphadenectomy in gastric cancer patients with liver cirrhosis. Methods: A total of 7 178 patients were admitted with a diagnosis of liver cirrhosis from January 1993 to December 2003. We reviewed the records of 142 patients who were diagnosed with liver cirrhosis and gastric adenocarcinoma during the same period. Gastrectomy with D2 lymph node dissection for carcinoma of the stomach was performed in 94 patients with histologically proven hepatic cirrhosis. Results: All but 12 patients were classified as Child's class A. Only 35 patients (37.2%) were diagnosed with cirrhosis before operation. Seventy-three patients underwent a subtotal gastrectomy (77.7%) and 21 patients (22.3%) underwent a total gastrectomy, each with D2 or more lymph node dissection. Two patients (3.8%) who had prophylactic intra-operative drain placement, died of postoperative complications from hepatorenal failure with intractable ascites. Thirty-seven patients (39.4%) experienced postoperative complications. The extent of gastric resection did not influence the morbidity whereas serum aspartate aminotransferase level (P = 0.011) and transfusion did (P = 0.008). The most common postoperative complication was ascites (13.9%) followed by wound infection (10.6%). Conclusion: We concluded that the presence of compensated cirrhosis, i.e. Child class A, is not a contra indication against gastrectomy with D2 or more lymph node dissection, when curative resection for gastric cancer is possible. Hepatic reserve and meticulous hemostasis are the likely determinants of operative prognosis.

AB - Aim:To explore the feasibility of performing gastrectomy with D2 lymphadenectomy in gastric cancer patients with liver cirrhosis. Methods: A total of 7 178 patients were admitted with a diagnosis of liver cirrhosis from January 1993 to December 2003. We reviewed the records of 142 patients who were diagnosed with liver cirrhosis and gastric adenocarcinoma during the same period. Gastrectomy with D2 lymph node dissection for carcinoma of the stomach was performed in 94 patients with histologically proven hepatic cirrhosis. Results: All but 12 patients were classified as Child's class A. Only 35 patients (37.2%) were diagnosed with cirrhosis before operation. Seventy-three patients underwent a subtotal gastrectomy (77.7%) and 21 patients (22.3%) underwent a total gastrectomy, each with D2 or more lymph node dissection. Two patients (3.8%) who had prophylactic intra-operative drain placement, died of postoperative complications from hepatorenal failure with intractable ascites. Thirty-seven patients (39.4%) experienced postoperative complications. The extent of gastric resection did not influence the morbidity whereas serum aspartate aminotransferase level (P = 0.011) and transfusion did (P = 0.008). The most common postoperative complication was ascites (13.9%) followed by wound infection (10.6%). Conclusion: We concluded that the presence of compensated cirrhosis, i.e. Child class A, is not a contra indication against gastrectomy with D2 or more lymph node dissection, when curative resection for gastric cancer is possible. Hepatic reserve and meticulous hemostasis are the likely determinants of operative prognosis.

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