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PubMedDate not supplied

Reconstructive procedure after distal gastrectomy to prevent remnant gastritis.

BACKGROUND/AIMS: Gastroduodenostomy (Billroth I) or gastrojejunostomy (Billroth II) after distal gastrectomy is associated with duodenogastric reflux and remnant gastritis. This study sought to determine which reconstructive procedure is least likely to cause remnant gastritis and to determine the correlation between duodenogastric reflux and remnant gastritis. METHODOLOGY: Sixty patients who underwent curative distal gastrectomy for gastric cancer were classified into three groups by reconstructive procedure: group A, Roux-Y (n=18); group B, Billroth I (n=25); group C, Billroth II (n=17). Intragastric bile reflux was monitored using the Bilitec 2000 14 days after surgery, and endoscopy was performed and a patient questionnaire was completed 12 weeks after surgery. RESULTS: Bile reflux occurred in 23.9%, 40.4%, and 73.4% of the time (p<0.001), and remnant gastritis developed in 33%, 76%, and 100% of patients (p<0.001), in groups A, B, and C, respectively. Helicobacter pylori infection did not correlate with remnant gastritis (p=0.57). Symptoms following Roux-Y reconstruction were comparable to those following Billroth I and II reconstructions. CONCLUSIONS: Roux-Y reconstruction following distal gastrectomy is superior to Billroth I and II reconstruction in preventing remnant gastritis because it reduces duodenogastric reflux.

Aged↗
PubMedDate not supplied

Total gastrectomy reconstructed by interposition of a jejunal J pouch with preservation of hepatic vagus branch and lower esophageal sphincter for T2 gastric cancer without lymph node metastasis.

BACKGROUND/AIMS: In order to improve postgastrectomy disorders of patients with T2 (MP or SS) gastric cancer without lymph node metastasis, which mainly locates in the middle third of stomach, we have performed a total gastrectomy preserving both hepatic vagus branches and the lower esophageal sphincter as a function-preserving surgical procedure. METHODOLOGY: In the present study, the application criteria and points of the technique are outlined, and postoperative quality of life is clinically investigated. Twenty-four subjects who underwent this surgical operation (group A; 16 men and 8 women subjects aged 46 to 73 years, mean age 62.2 years) were interviewed regarding appetite, weight loss, reflux esophagitis, dumping syndrome, and microgastria. Cholelithiasis following total gastrectomy was also checked by abdominal ultrasonography. Group A was compared with 26 cases of conventional total gastrectomy with D2 lymphadenectomy, excision of lower esophageal sphincter, total vagotomy, and single jejunal interposition (B group; 19 men and 7 women subjects aged 42 to 75 years, mean age 64.8 years). Application criteria of the technique: Included were cases with T2 cancer of N0 mainly localizing at the middle-third of the stomach which was 4 cm or further in distance from the oral-side margin of the cancer to the esophagogastric mucosa junction. Points of the technique: In lymphadenectomy, hepatic branches of the vagal nerve only preserved. To preserve lower esophageal sphincter, the abdominal esophagus was severed at the level of His angle to the longitudinal axis of the esophagus. Substitute stomach was created as a 15-cm jejunal pouch with a 5-cm-long jejunal conduit for isoperistaltic movement. RESULTS: In group A the food ingestion rate was significantly greater than that of group B (P<0.001) at 6 months and 2.0 years after operation, with no reflux esophagitis or dumping syndrome being noticed at 2.0 years after operation. In group B, loss of appetite 2.0 years after operation was significantly higher than that in group A (P<0.01). In addition, symptomatic reflux esophagitis (heartburn, dyspepsia, regurgitation) developed more significantly in group B than in group A (P<0.05). For food ingestion per time, group B was significantly delayed compared with group A (P<0.05). Body weight loss in group B was significantly higher than that in group A (P<0.01). Postgastrectomy cholelithiasis was detected significantly more in group B than in group A (P<0.05). CONCLUSIONS: These results suggested that the surgical technique proposed is safe and leads to a satisfactory symptomatic and nutritional result, and that this procedure is a function-preserving gastric surgery appropriate to prevent postgastrectomy disorders of subjects for T2 gastric cancer without lymph node metastasis, mainly located in the middle-third of stomach.

Adult↗
PubMedDate not supplied

Correlation between duodenogastric reflux and remnant gastritis after distal gastrectomy.

BACKGROUND/AIMS: Many patients who undergo distal gastrectomy develop remnant gastritis. This report describes the correlation between remnant gastritis and the amount of duodenogastric reflux and looks at the relationship between Helicobacter pylori infection and duodenogastric reflux in remnant gastritis. METHODOLOGY: Sixty-two patients who underwent curative distal gastrectomy for gastric cancer with radical lymphadenectomy were studied. The period of bile reflux (percent time) into the gastric remnant was measured with the Bilitec 2000 under standardized conditions. Remnant gastritis was semi-quantified using the neutrophil infiltration score based on the updated Sydney System, and the presence of H. pylori infection was determined 12 weeks after the surgery. RESULTS: Overall, the correlation was not significant between the neutrophil infiltration score and the percent time (p=0.08). Similarly, the correlation was not significant in patients with H. pylori infection (p=0.30), but it was significant in patients without H. pylori infection (p=0.03). CONCLUSIONS: Duodenogastric reflux after distal gastrectomy can cause remnant gastritis in patients without H. pylori infection. Reconstruction with biliary diversion is protective against the development of remnant gastritis.

Adult↗
PubMedDate not supplied

Iron deficiency anemia after subtotal gastrectomy for gastric cancer.

BACKGROUND/AIMS: Sideropenic anemia after a gastrectomy is a frequent complication. The aim of the present study was to evaluate the role of different factors, such as sex, age, atrophic chronic gastritis, Helicobacter pylori infection and iron malabsorption, in iron deficiency after surgery for gastric cancer. METHODOLOGY: Thirty-seven patients who underwent subtotal gastrectomy for carcinoma of the stomach were prospectively studied following a specific three-year protocol. Iron deficiency was evaluated by hemochromocytometric analysis and serum iron-ferritin level assays. RESULTS: Of the different variables analyzed, atrophic chronic gastritis was associated with a lower mean serum iron level, in particular two years after surgery (65mg/dL vs. 103 mg/dL in subjects without gastritis, P<0.01); a correlation between Helicobacter pylori infection of the gastric stump and lower mean serum ferritin level was also found (25+/-6.3 mg/dL vs. 53+/-0.4 mg/dL, P<0.05). On the contrary, no association was observed with the other factors that were evaluated. CONCLUSIONS: Among the factors involved in iron deficiency after gastrectomy for cancer of the stomach, atrophic gastritis seems to be the most important, although Helicobacter pylori infection of the gastric stump also seems to play an important role.

Adenocarcinoma↗
PubMedDate not supplied

Effect of H. pylori on COX-2 expression in gastric remnant after distal gastrectomy.

BACKGROUND/AIMS: Helicobacter pylori infection is known to induce gastritis, oxidative stress, and cyclooxygenase (COX)-2 expression in the gastric mucosa. However, the effect of H. pylori infection on remnant gastritis has not been studied. We investigated whether the severity of remnant gastritis and COX-2 expression were affected by H. pylori infection after distal gastrectomy. METHODOLOGY: The study included 97 patients with gastric cancer who underwent curative distal gastrectomy with lymphadenectomy in our department between May 1999 and April 2001. All patients underwent endoscopic examination 2 weeks before and 12 weeks after surgery. The presence of H. pylori infection was determined by urease activity, hematoxylin-eosin staining, and immunochemical staining. Histologic remnant gastritis was graded based on the degree of neutrophil infiltration using the updated Sydney System. COX-2 expression was estimated immunohistochemically. RESULTS: Both the degree of neutrophil infiltration and the level of COX-2 expression were significantly higher in patients with than without H. pylori (p<0.05). There was a significant correlation between the degree of neutrophil infiltration and the degree of COX-2 expression (p<0.001). CONCLUSIONS: H. pylori eradication may become a treatment for preventing both remnant gastritis as well as remnant gastric carcinoma after distal gastrectomy.

Adult↗
PubMedDate not supplied

Helicobacter pylori infection in patients with ulcer recurrence after partial gastrectomy.

BACKGROUND/AIMS: Recurrent ulceration of the stomach occurs in some patients after surgery for peptic ulcer disease. The aim of this study is to evaluate the association of Helicobacter pylori infection with ulcer recurrence in patients after partial gastrectomy due to peptic ulcer disease. METHODOLOGY: A total of 186 patients after partial gastrectomy with Billroth I or Billroth II anastomosis presenting with dyspepsia or bleeding were included. An ulcer recurrence was documented by endoscopic examination. Biopsy specimens were taken from the remnant gastric bodies in all patients. H. pylori infection was diagnosed by either a positive biopsy urease test or the presence of the microorganism on histology. RESULTS: Eighty-three (44.6%) patients among the 186 patients had recurrent ulcers. H. pylori infection was found in 29 (36%) patients in the ulcer group and 42 (41%) patients in the non-ulcer group. The incidence of H. pylori infection did not differ significantly between the two groups (P>0.05). CONCLUSIONS: H. pylori infection may not play an important role in the pathogenesis of recurrent ulcer after partial gastrectomy. Other factors should be studied further.

Adult↗
PubMed1992

[Clinical experience of reoperation for anastomotic stricture following proximal gastrectomy for esophageal varices].

A few cases were reported in which second reconstructive operation on gastrointestinal tract for reflux esophagitis following the proximal gastrectomy was performed. But no previous report of the removal of anastomotic region for treating anastomotic stricture due to reflux esophagitis has appeared. Also, there are no reports on second operations to treat anastomotic strictures following proximal gastrectomy for esophageal varices. We report a case in which we obtained favorable results in treating an anastomotic stricture due to reflux esophagitis, which developed following a proximal gastrectomy for esophageal varices, by performing removal of the anastomotic region and resection of the remaining stomach with reconstruction by the Roux-en Y method.

Aged↗
PubMedDate not supplied

Accelerated rehabilitation with early postoperative oral feeding following gastrectomy.

BACKGROUND/AIMS: To evaluate the safety and efficacy of early oral feeding in patients undergoing gastrectomy. METHODOLOGY: One hundred patients undergoing gastrectomy were studied. Patients in the early oral feeding group (Early group) began a liquid diet within 48 hours after operation and patients within the Traditional group received nothing by mouth until the resolution of the ileus. All of the patients were monitored for vomiting, abdominal distention, length of ileus, tolerance of regular diet, duration of intravenous fluid administration, length of hospitalization, and complications. RESULTS: The time to flatus was 55.5+/-12.5 hours and 78.0+/-22.2 hours in the Early and Traditional group, respectively (p<0.05). And fasting period was 2.14+/-1.08 days and 5.93+/-2.35 days in the Early and Traditional group, respectively (p<0.05). In addition, duration of intravenous fluid administration was shorter in the patients in the Early group compared with Traditional group (5.7+/-1.7 days vs. 9.2+/-3.9 days, p<0.05). As a result, length of postoperative hospitalization in the patients in the Early group was significantly shorter than those in the Traditional group (16.2+/-5.3 days vs. 23.4+/-9.8 days, p<0.05). The incidence of complications including nausea, vomiting, anastomotic leak and wound infection occurred equally in both groups. CONCLUSIONS: Early oral feeding after gastrectomy is safe, with no evidence of increased morbidity, and early postoperative oral feeding is also highly effective in reducing hospital stay.

Adult↗
PubMed1992

Short-term results of gastrectomy with Roux-en-Y or Billroth II anastomosis for peptic ulcer. A prospective comparative study.

Since the Roux-en-Y anastomosis prevents the sequela of postoperative enterogastric reflux after gastrectomy, this approach has been advocated as the primary procedure in patients undergoing gastrectomy for peptic ulcer. We have prospectively followed for 2 years 22 patients, in whom gastrectomy was performed with, at random, either Roux-en-Y (n = 11) or Billroth II (n = 11) anastomosis. Two of the 11 patients who had received the Roux-en-Y procedure had anastomotic ulcers, leading to reresection in one of them. These two patients were found to have the highest values for basal and pentagastrin stimulated gastric acid output. After the Billroth II procedure a single patient had a small anastomotic ulcerative lesion. Apart from differences in intragastric bile acids (p less than 0.0001) and the gastritis activity score (p less than 0.01), no significant differences were found between the patients with Roux-en-Y and Billroth II anastomosis with respect to basal and pentagastrin-stimulated gastric acid secretion, basal, postprandial and bombesin-stimulated serum gastrin secretion, serum pepsinogen A and C concentrations, the serum pepsinogen A/C ratio, postprandial glucose, and for a modified Visick grading. From this small series we conclude that, as compared with the Billroth II-anastomosis, the Roux-en-Y procedure effectively prevents enterogastric reflux, and is associated with a higher gastritis activity score, but not with differences in gastric acid, gastrin, pepsinogens, or Visick grading. Furthermore, inadequate reduction of acid secretion in some patients after the Roux-en-Y procedure may lead to recurrent peptic ulcers.

Anastomosis, Roux-en-Y↗
PubMedDate not supplied

Laparoscopy-assisted and open distal gastrectomies for early gastric cancer at a general hospital in Japan.

BACKGROUND/AIMS: At general hospitals in Japan, laparoscopic surgery for early gastric cancer is not yet popular. The benefits and feasibility of this procedure remain to be established. The aim of this study was to evaluate the surgical outcome of laparoscopy-assisted distal gastrectomy (LADG) in comparison with open distal gastrectomy (ODG) in a general hospital. METHODOLOGY: We performed LADG in 20 patients with early gastric cancer between 2000 and 2001. Clinicopathologic data, blood analyses, clinical course and financial cost of treating patients with LADG were compared with 22 patients treated with ODG between 1998 and 1999. RESULTS: All patients were treated successfully by LADG. Neither reduced operative curability nor increased complications were found with this procedure. Although LADG required a significantly longer operation time than ODG, blood loss was lower in LADG than in ODG. The leukocyte count on day 1 and day 3, and serum C-reactive protein levels on day 1 were significantly lower after LADG than after ODG. There was no significant difference between LADG and ODG in the period and volume of analgesics required. High body temperature continued longer after ODG than after LADG. The first walking, passage of flatus and oral diet initiation were significantly earlier in patients with LADG than in those with ODG. LADG required a significantly shorter hospital stay and less total hospital charge than ODG. CONCLUSIONS: Laparoscopy-assisted distal gastrectomy offered faster recovery of gastrointestinal function, a shorter hospital stay, and consequently less financial cost when compared with open surgery. Therefore, LADG may be a safe and recommendable procedure for patients with early gastric cancer at general hospitals in Japan.

Blood Loss, Surgical↗
PubMedDate not supplied

Total gastrectomy for gastric carcinoma.

BACKGROUND/AIMS: Gastric cancer is one of the most common organ cancers all around the world and surgical resection is essential for treatment. Total gastrectomy is the procedure of choice for treatment of proximal gastric cancer. Mortality and morbidity risks of this procedure are high, especially among the elderly. METHODOLOGY: Thirty-eight gastric cancer patients underwent total gastrectomy in the Third Surgical Clinic of Izmir Ataturk Training and Research Hospital between 1996 and 2001. Age, gender, location of the tumor, histopathological findings, TNM stage, type of anastomosis, operation time, blood transfusions, oral food intake, postoperative hospital stay, morbidity, mortality both early and late, and survival rate were evaluated. RESULTS: Mean age of the patients was 59.5 years (22-85 years). Sites of the tumors were: cardia 28.9%, cardia and corpus 15.8%, corpus 34.3%, corpus and antrum 18.4%, linitis plastica 2.6%. Histological types were adenocarcinoma (97.4%), and squamous cell carcinoma (2.6%). TNM stages were: stage la 2.6%, stage II 7.9%, stage IIIa 39.5%, stage IIIb 42.1%, and stage IV 7.9%. Esophagojejunostomies were performed manually (34.3%) or by circular staplers (65.7%). Operation time ranged between 3 and 6.5 hours. Gastric tubes were removed on the fourth postoperative day. Average postoperative hospital stay was 12.9 days. Postoperative morbidity was 21%. Wound infection occurred in three patients (7.9%), pulmonary infection occurred in two patients (5.2%) and anastomotic stricture developed in three patients (7.9%). Hospital mortality was 20%. Anastomotic leak occurred in five cases (13.2%) and all died on days 8, 13, 14, 26, and 30. Three patients (7.9%) died of cardiac complications on days 1, 5, and 29. Twelve patients survived for less than one year and eight patients survived for one to two years. Average survival was 10.5 months for 20 out of 30 patients (median 8 months). Ten patients are still alive after 14.3 months. Four patients have been living for less than one year, another four patients for one to two years, and two patients for more than two years. CONCLUSIONS: Total gastrectomy, either performed with a curative or palliative aim, is a safe procedure with acceptable mortality rates. 89.5% of our cases were stage III or IV resulting in a low survival rate. Longer survival rates can be achieved in patients with comparatively earlier stages.

Adenocarcinoma↗
PubMed2005

[Surgical treatment of massive rebleeding after gastrectomy for bleeding gastroduodenal ulcer].

OBJECTIVE: To summarize the reoperation experiences in treatment of massive rebleeding after subtotal gastrectomy for bleeding gastroduodenal ulcer. METHODS: From 1980 to 2002, clinical data of 26 cases with massive rebleeding after subtotal gastrectomy for bleeding gastrorenal ulcer were analyzed retrospectively. RESULTS: Preoperative gastroscopy was performed in 6 cases, intraoperative gastroscopy in 11, and preoperative superselective angiography in 2 cases. Eleven cases with left ulcer or post- bulb ulcer bleeding underwent resection of the left ulcer or longitudinal incision of the duodenal descending part and direct hemostasis. Thirteen cases with anastomotic stoma bleeding underwent local suture hemostasis or resection of the stoma plus Billroth II or Roux- en- Y gastrojejunostomy. Two cases with gastric bleeding received reexcision of the stomach remnant. Twenty- four cases (92.3% ) were cured and 2 cases (7.7% ) died of gastric bleeding. CONCLUSION: Preoperative superselective angiography and intraoperative gastroscopy are beneficial to clarify the bleeding position and causes for massive rebleeding after gastrectomy. It is very important to select proper operative method to prevent postoperative rebleeding.

Adult↗
PubMed2005

[Diagnosis and treatment of functional delayed gastric emptying after gastrectomy].

OBJECTIVE: To explore the clinical characteristics and treatment of functional delayed gastric emptying(FDGE) after gastrectomy. METHODS: From 1998 to 2003, clinical data of 224 patients undergone gastrectomy were analyzed retrospectively. RESULTS: Nine of 224 patients (4%) had FDGE from three days to ten days (average 7.2 days) after operation. Diagnosis was confirmed by clinical features,gastric contrast examination and gastroscope. The incidence of FDGE was 6.1% in the patients treated with Billroth II gastroenterostomy, which was higher than that with Billroth I gastroenterostomy (1.8%). Eight patients were cured by palliative treatment with recovery time from 9 to 56 days (average 22 days), but one patient died of severe pulmonary infection. CONCLUSIONS: FDGE is a common and early complication after gastrectomy, PDGE is more likely to occur in patients with Billroth II gastroenterostomy. Diagnosis can be confirmed by barium meal examination of gastrointestinal tract and gastroscopy. PDGE can be mostly cured by palliative treatment.

Adult↗
PubMed2001

[Carcinogenicity of duodenogastric reflux juice in patients undergoing gastrectomy].

OBJECTIVE: To determine the carcinogenic potential of reflux juice from patients undergoing remote gastrectomy and to clarify the relationship between duodenogastric reflux and gastric stump cancer. METHODS: A total of 37 reflux juice samples (13 Billroth I, 24 Billroth II) were used. A two-stage transformation assay using BALB/c 3T3 cells was carried out to test the initiating or promoting activity of the samples. RESULTS: 11.1% reflux samples showed initiating activities, whereas 47.4% samples enhanced the MNNG-initiating cell transformation, suggesting that duodenogastric reflux juice might possess tumor-promoter activity (P < 0.05). There was no difference in initiating activities of the samples irrespective of surgical procedures (P > 0.05). Billroth II samples exhibited stronger tumor-promoter activity than Billroth I samples (P < 0.05), in accordance with many epidemic findings that this cancer preferred to Billroth II procedure. The promoter activities were well correlated with the histological changes of the stomas (r(s) = 0.625, P < 0.01), but both their cytotoxicities and initiating activities failed to show this correlation. CONCLUSIONS: The duodenogastric reflux juice from patients undergoing remote gastrectomy has tumor-promoting activity on initiating activity. It is suggested that tumor-promoting potential should be responsible for the high incidence of gastric carcinoma in the patients undergoing remote gastrectomy. Thus a direct evidence for the etiology of gastric stump carcinoma is provided.

Adult↗
PubMed2005

[Residual stomach, duodenum, and continual jejunal interposition after subtotal gastrectomy].

OBJECTIVE: To investigate the clinical effect of residual stomach, duodenum, and continual jejunal interposition on the patients of gastric cancer after subtotal gastrectomy. METHODS: Fifty-four patients with gastric cancer after subtotal gastrectomy were randomly divided into 2 groups: Group A (n = 26, receiving digestive tract reconstruction by manual end-to-side anastomosis of residual stomach and jejunum, end-to-side anastomosis of residual duodenum and jejunum, and side-to-side anastomosis of jejunum and jejunum, then the jejunum proximal to the stomach-jejunum anastomosis and the jejunum distal to the duodenum-jejunum anastomosis were ligated so as to form an integral continual jejunal interposition; and Group B (n = 28, receiving Bilroth digestive tract reconstruction. The operation time, body weight, prognosis nutrition index (PNI), and Visick score 3 and 6 months after the operation were observed. RESULTS: All patients recovered quickly and no complicating anastomosis leakage and obstruction was found. It took 53 +/- 9 minutes to finish the reconstruction in Group A, significantly shorter than that in Group B (57 +/- 6 minutes, t = -2.145, P = 0.037). The body weight and PNI of both groups decreased significantly 3 months after the operation in comparison with those before the operation (both P < 0.05). The body weight and PNI of Group A returned to the levels before operation. Although the body weight and PNI of Group B recovered to some extent 6 months after operation, they remained significantly lower than those before operation both P < 0.05). The Visick score 6 months after operation of Group A was superior to that of Group B (t = 2.1 P < 0.05). CONCLUSION: Residual stomach, duodenum, and continual jejunal interposition after subtotal gastrectomy helps overcome the difficulty in the procedure of digestive tract reconstruction and restore the physiological passage through duodenum, thus avoiding reflux and improving patients' quality of life.

Adult↗
PubMed2005

Quality of life in patients with esophagojejunal anastomosis after total gastrectomy for cancer.

OBJECTIVE: To analyze the influence of the esophagojejunostomy type (Roux-en-Y end-to-end or end-to-side, omega, manual or mechanic), of the associated resections and postoperative complications, on patients' Quality of Life (QoL) after total gastrectomy for cancer. METHODS: From 1997 to 2004 63 patients underwent a total gastrectomy for cancer. Patients were invited to fill a questionnaire with 14 treatment-specific related symptoms at 3 and respectively 12 months postoperatively. The present study comprises 39 patients, all without cancer recurrence, who completed all required items. RESULTS: The QoL was not influenced by the patients' age and gender, associated resections or by the esophagojejunostomy type. Anastomotic fistula significantly influenced patients' appetite at 3 months (p=0.013). At 12 months postoperatively there was a significant difference between the patients' body weight when end-to-end anastomosis were compared to end-to-side anastomosis (p=0.023). The patients' QoL improved in a significant manner at 12 months postoperatively, compared to their QoL at 3 months. CONCLUSIONS: After total gastrectomy for cancer, patients' QoL is not significantly influenced by the type of the esophagojejunostomy. The end-to-end esojejunal anastomosis seems to have a less deleterious effect on the postoperative weight loss. Anastomotic fistula remains the only complication with some influence on patients' QoL in the first postoperative months.

Adult↗
PubMed2006

[Comparison of two reconstruction methods of alimentary canal after total gastrectomy].

OBJECTIVE: To evaluate the clinical value of two alimentary reconstruction methods after total gastrectomy for gastric cancer. METHODS: Thirty- one patients undergoing total gastrectomy for gastric cancer were prospectively randomly divided into two groups: single-canal jejunum interposition (n=16, group A) and P pouch with Roux-en-Y esophagojejunostomy (n=15, group B). All patients were followed up for one year. The serum nutritional parameters,body weight change and clinical effects between the two groups were compared. RESULTS: Both of the reconstruction types had the replacement of gastric function. The hemoglobin level was (102+/- 11)g/L, the total protein level (6.8+/- 3.9)g/L, and the body weight loss (1.0+/- 1.7)kg in group A, while (98+/- 12)g/L, (6.3+/- 3.0)g/L and (4.0+/- 2.3)kg in group B. There were significant differences between the two groups (all P< 0.05). CONCLUSION: The single-canal jejunum interposition reconstruction after total gastrectomy (Henley) is a better surgical method.

Adult↗
PubMed2006

[Risk factors of elderly patients with total gastrectomy for gastric cancer].

OBJECTIVE: To analyze the relative risk factors of elderly patients with total gastrectomy for gastric cancer. METHODS: The risk factors for hospital death and postoperative complications in 131 elderly patients undergoing total gastrectomy for gastric cancer from Aug. 1994 to Aug. 2004 were analyzed retrospectively. RESULTS: The risk factors for hospital death and postoperative complications included coexistent diseases, hemoglobin level less than 80 g/L, albumin level less than 35 g/L, body mass index(BMI) less than 18.5 kg/m (2), intraoperative blood loss more than 1000 ml, operating time longer than 5 h, combined resection of the spleen or pancreas. The relative risks were 1.57, 1.74, 2.97, 4.23, 2.21, 2.28, 3.80 respectively for hospital death, and 1.50, 1.90, 2.38, 2.12, 2.45, 1.66, 3.41 for postoperative complications. CONCLUSION: The risk factors of the elderly patients with total gastrectomy for gastric cancer should be considered carefully during the perioperative period. It can increase the security of the procedure to control these risk factors.

Aged↗