SURGERY FOR GASTRIC-CANCER IN PATIENTS WITH CIRRHOSIS

To clarify the therapeutic strategies for gastric cancer surgery in th e presence of cirrhosis, 39 patients with gastric cancer accompanied b y liver cirrhosis were reviewed, Severe postoperative complications de veloped in 10 patients (25.6%), and there were 4 (10.3%) hospital deat hs, 1 (2.6%) of which occurred within 1 month, Although extended lymph node dissection of D-2 or more was adopted for low-risk patients, 3 o f 19 patients who underwent such extensive operations, most of which i nvolved complete lymph node dissection in the hepatoduodenal ligament, died. Conversely, only 1 of 20 patients who underwent limited lymph n ode dissection of D-1 or less died, Postoperative massive ascites deve loped in 6 patients, 3 of whom died, The cumulative 5-year survival ra te following curative resection was 63.7% for patients with early gast ric cancer, and 13.9% for those with advanced gastric cancer, The most frequent cause of death was cirrhosis-related, such as hepatic failur e or hepatoma, In conclusion, extensive lymph node dissection for pati ents with gastric cancer accompanied by cirrhosis carried a risk of po stoperative fatal massive ascites as lymphorrhea. Thus, lymph node dis section in the hepatoduodenal ligament should be avoided, except in pa tients with evident metastases, and as a rule, aggressive surgery shou ld not be performed in cirrhotic patients.