J Gastric Cancer.  2022 Jul;22(3):210-219. 10.5230/jgc.2022.22.e19.

Postoperative Complications and Their Risk Factors of Completion Total Gastrectomy for Remnant Gastric Cancer Following an Initial Gastrectomy for Cancer

• Park SH
• Eom SS
• Eom BW
• Yoon HM
• Kim YW
• Ryu KW

• KMID: 2535102
• DOI: http://doi.org/10.5230/jgc.2022.22.e19

Abstract

Purpose
Completion total gastrectomy (CTG) for remnant gastric cancer (RGC) is a technically demanding procedure and associated with increased morbidity. The present study aimed to evaluate postoperative complications and their risk factors following surgery for RGC after initial partial gastrectomy due to gastric cancer excluding peptic ulcer.
Materials and Methods
We retrospectively reviewed the data of 107 patients who had previously undergone an initial gastric cancer surgery and subsequently underwent CTG for RGC between March 2002 and December 2020. The postoperative complications were graded using the Clavien-Dindo classification. Logistic regression analyses were used to determine the risk factors for complications.
Results
Postoperative complications occurred in 34.6% (37/107) of the patients. Intraabdominal abscess was the most common complication. The significant risk factors for overall complications were multi-visceral resections, longer operation time, and high estimated blood loss in the univariate analysis. The independent risk factors were multivisceral resection (odds ratio [OR], 2.832; 95% confidence interval [CI], 1.094–7.333; P=0.032) and longer operation time (OR, 1.005; 95% CI, 1.001–1.011; P=0.036) in the multivariate analysis. Previous reconstruction type, minimally invasive approach, and current stage were not associated with the overall complications.
Conclusions
Multi-visceral resection and long operation time were significant risk factors for the occurrence of complications following CTG rather than the RGC stage or surgical approach. When multi-visceral resection is required, a more meticulous surgical procedure is warranted to improve the postoperative complications during CTG for RGC after an initial gastric cancer surgery.

Keyword

Morbidity; Stomach neoplasm; Gastrectomy; Gastric stump