POSTOPERATIVE COMPLICATIONS REQUIRING RELAPAROTOMIES AFTER 700 GASTRECTOMIES PERFORMED FOR GASTRIC-CANCER

BACKGROUND: Prevention of fatal postoperative complications and improv ed management of patients with complications are important means of in creased survival in gastric cancer patients. PATIENTS AND METHODS: A s tudy of 700 patients undergoing gastrectomy was performed to examine f actors that contributed to a high rate of postoperative complications. RESULTS: Of 700 patients undergoing gastrectomy for adenocarcinoma, 4 0 (5.7%) underwent reexploration because of serious complications. The frequency of the relaparotomies varied from 2.1% and 4.4% after regul ar subtotal and total gastrectomies, respectively, to 20% and 30.4% af ter palliative and conventional total gastrectomies, respectively. The complications that required reexploration most frequently were anasto motic leakage and incompetence of sutures (11, 27.5%), intra-abdominal abscesses (8, 20%), and pancreatic necrosis (7, 17.5%). A combination of preventive measures allowed the attainment of low rates of esophag ojejunal anastomotic leakage (0.8%). CONCLUSION: We believe that the d ecision to perform an urgent reexploration, based on clinical findings , should generally be made by a group of experienced surgeons (not onl y the primary surgeon). Timely relaparotomy prevented death in 37.5% o f the patients with serious acute postoperative complications.