J Korean Surg Soc.  2010 Nov;79(5):349-354. 10.4174/jkss.2010.79.5.349.

The Clinical Outcome of Combined Organ Resection during Radical Gastrectomy

• Song YJ
• Jeong SH
• Lee YJ
• Park ST
• Choi SK
• Hong SC
• Jung EJ
• Joo YT
• Jeong CY
• Ha WS

• KMID: 2212040
• DOI: http://doi.org/10.4174/jkss.2010.79.5.349

Abstract

PURPOSE
Combined organ resection is a common operation in gastric cancer surgery. The aim of this study is to investigate the risk of combined minor organ resection (GB, gynecologic organ, appendix etc) in gastric cancer surgery.
METHODS
The clinical data from 673 consecutive patients who underwent gastrectomy for gastric cancer at a single center were retrospectively analyzed. We investigated clinical data between open groups (OG) and laparoscopy groups (LAG), and we divided the patients into 3 groups: no resection group, minor organ resection group and major organ (spleen, pancreas, and colon) resection group.
RESULTS
There were higher complication rates in major organ resection group (59.3%, 53.8%) than no resection (32.3%, 19.1%) or minor organ resection groups (38.7%, 20%) both in OG and LAG (P<0.05). However, there were longer hospital stays in minor (22.2 days) and major resection groups (24.1) than no resection group (16.2) in OG, but stays were longer in major resection group (30.9) than minor (14.5) and no resection group (16.2) in LAG (P<0.01). Operative times were longer in minor (287 min) and major organ resection group (310) than no resection group (243) in OG (P<0.00). However, operation time was longer in major resection group (505) than minor (415) and no resection group (370) in LAG (P=0.00).
CONCLUSION
Combined minor organ resection with gastrectomy does not increase morbidity, and there is no statistical difference in hospital stay and op time than no resection group in LAG.

Keyword

Gastric neoplasm; Gastrectomy; Cholecystectomy; Combined organ resection

MeSH Terms

Appendix
Cholecystectomy
Gastrectomy
Humans
Laparoscopy
Length of Stay
Operative Time
Pancreas
Retrospective Studies
Stomach Neoplasms

Reference

1. Ozer I, Bostanci EB, Orug T, Ozogul YB, Ulas M, Ercan M, et al. Surgical outcomes and survival after multiorgan resection for locally advanced gastric cancer. Am J Surg. 2009. 198:25–30.

2. Martin RC 2nd, Jaques DP, Brennan MF, Karpeh M. Extended local resection for advanced gastric cancer: increased survival versus increased morbidity. Ann Surg. 2002. 236:159–165.

3. Hiratsuka T, Ohta M, Sonoda K, Yamamura S, Nishizaki T, Matsusaka T, et al. Simultaneous operation of laparoscopy-assisted distal gastrectomy with laparoscopic cholecystectomy. Hepatogastroenterology. 2007. 54:1645–1647.

4. Park DJ, Lee HJ, Kim HH, Yang HK, Lee KU, Choe KJ. Predictors of operative morbidity and mortality in gastric cancer surgery. Br J Surg. 2005. 92:1099–1102.

5. Colen KL, Marcus SG, Newman E, Berman RS, Yee H, Hiotis SP. Multiorgan resection for gastric cancer: intraoperative and computed tomography assessment of locally advanced disease is inaccurate. J Gastrointest Surg. 2004. 8:899–902.

6. Jeong IH, Choi SU, Lee SR, Kim JH, Park JM, Jin SH, et al. Outcomes after combined laparoscopic gastrectomy and laparoscopic cholecystectomy in gastric cancer patients. Eur Surg Res. 2009. 42:203–208.

7. Bonenkamp JJ, Songun I, Hermans J, Sasako M, Welvaart K, Plukker JT, et al. Randomised comparison of morbidity after D1 and D2 dissection for gastric cancer in 996 Dutch patients. Lancet. 1995. 345:745–748.

8. Cuschieri A, Fayers P, Fielding J, Craven J, Bancewicz J, Joypaul V, et al. The Surgical Cooperative Group. Postoperative morbidity and mortality after D1 and D2 resections for gastric cancer: preliminary results of the MRC randomised controlled surgical trial. Lancet. 1996. 347:995–999.

9. Bloechle C, Izbicki JR, Limmer J, Kühn R, Hosch SB, Busch C, et al. Multi-visceral resection for locally advanced gastric cancer. Acta Chir Belg. 1995. 95:72–75.

10. Yong WS, Wong WK, Chan HS, Soo KC. Extended resection of locally advanced (T4) stomach cancer. Ann Acad Med Singapore. 2000. 29:723–726.

11. Dhar DK, Kubota H, Tachibana M, Kinugasa S, Masunaga R, Shibakita M, et al. Prognosis of T4 gastric carcinoma patients: an appraisal of aggressive surgical treatment. J Surg Oncol. 2001. 76:278–282.

12. Kasakura Y, Fujii M, Mochizuki F, Kochi M, Kaiga T. Is there a benefit of pancreaticosplenectomy with gastrectomy for advanced gastric cancer? Am J Surg. 2000. 179:237–242.

13. Persiani R, Antonacci V, Biondi A, Rausei S, La Greca A, Zoccali M, et al. Determinants of surgical morbidity in gastric cancer treatment. J Am Coll Surg. 2008. 207:13–19.

14. Salom EM, Schey D, Peñalver M, Gómez-Marín O, Lambrou N, Almeida Z, et al. The safety of incidental appendectomy at the time of abdominal hysterectomy. Am J Obstet Gynecol. 2003. 189:1563–1567. discussion 7-8.

15. O'Hanlan KA, Fisher DT, O'Holleran MS. 257 incidental appendectomies during total laparoscopic hysterectomy. JSLS. 2007. 11:428–431.