Postoperative Complications after Gastic Cancer Surgery in Liver Cirrhosis Patients

Kim, Wan Soo; Oh, Sung Tae; Kim, Byung Sik; Kim, Jin Cheon; Park, Kun Choon

Abstract

BACKGROUND/AIMS: Even an expert gastrointestinal surgeons would have fears of possible posto- perative morbidity and mortality for the cirrhotic patients although he had experienced only a few or none. This study was conducted to evaluate the postoperative morbidity and mortality of gastric cancer patients with accompanying liver cirrhosis who underwent gastric surgery in Asan medical center between January 1990 to December 1994.
METHODS
Among 1,732 cases of gastric surgery during this period, thirty-two(1.8/o) cases with liver cirrhosis were confirmed during laparotomy and their medical records were reviewed and analyzed retrospectively.
RESULTS
The TNM stages ofthe 32 patients were I:13 cases, II:6, III:4 and IV:9, respectively. Hepatic functional status of the patients according to Child class was A:17 cases, B:9 and C:6, respectively. Hepatitis B antigen was detected in 19 cases(59.4/o) and Hepatitis C antibody was detected in 5 cases(15.61o). The postoperative rnortality rate was 9.4/o(3/32) and morbidity rate was 34%(11/32). Types of operation were subtotal gastrectomy in 20 cases, total gastrectomy in 6 cases and exploratory laparotomy (open biopsy) in 6 cases. Among six cases of Child class C, postoperative complications occured in five patients including two cases of hepatic failure and two cases of mortality(due to hepatic failure and pneumonia). There was another mortality case in Child A group(due to hepatic failure) after exploratory laparotomy. Hepatic failure did not occur in the whole twenty-six cases who underwent radical gastrectomy.
CONCLUSION
Radica] gastrectomy can be perfortned safely even in liver cirrhosis patients if liver function is better than Child class C. Rather non-surgical treatment is recommended for Child class C gastric cancer patients to avoid high]y probable postoperative rnorbidity or mottality.