Post-operative morbidity and mortality following D2 gastrectomy in a state funded tertiary care centre in South India
DOI:
https://doi.org/10.18203/2349-2902.isj20194063Keywords:
D2 gastrectomy, Malnourished, Post-operative morbidityAbstract
Background: Radical gastrectomy with D2 lymphadenectomy is a surgery with significant post-operative morbidity. Pre-operative malnutrition portends a poor post-operative outcome following any gastrointestinal surgery in general. This study aims at finding out whether it is feasible to perform D2 lymphadenectomy in patients presenting with significant malnutrition.
Methods: In this single centre study, we retrospectively analysed the post-operative morbidity and mortality data of 46 patients who underwent D2 gastrectomy for operable gastric cancer between October 2016 to April 2019. Almost all the patients who were analysed fulfilled at least one criterion for malnutrition.
Results: The morbidity rate was 39.1% and the mortality rate was 6.5% which were a little high when compared to results from other Indian centres but not prohibitive, considering the nutritional status of these patients. Almost 50% of these patients were able to complete adjuvant chemotherapy.
Conclusions: D2 gastrectomy can be performed in patients with poor pre-operative nutritional status. If perioperative nutritional requirements are taken care of promptly, the post-operative outcomes can be better.
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References
Dikshit RP, Mathur G, Mhatre S, Yeole BB. Epidemiological review of gastric cancer in India. Indian J Med Paediatr Oncol. 2011;32(1):3–11.
Siewert JR, Fink U, Sendler A, Becker K, Bottcher K, Feldmann HJ, et al. Gastric cancer. Curr Probl Surg 1997;34:835-942.
Badgwell B, Blum M, Estrella J, Chiang YJ, Das P, Matamoros A, et al. Predictors of survival in patients with resectable gastric cancer treated with preoperative chemoradiation therapy and gastrectomy. J Am Coll Surgeons. 2015;221(1):83-90.
Yamamoto M, Rashid OM, Wong J. Surgical management of gastric cancer: the East vs. West perspective. J Gastrointes Oncol. 2015;6(1):79.
Bickenbach K, Strong VE. Comparisons of gastric cancer treatments: east vs. west. J Gast Cancer. 2012;12(2):55-62.
Degiuli M, De Manzoni G, Di Leo A, D’Ugo D, Galasso E, Marrelli D, et al. Gastric cancer: Current status of lymph node dissection. World J Gastroenterol. 2016;22(10):2875.
Abe Vicente M, Barão K, Silva TD, Forones NM. What are the most effective methods for assessment of nutritional status in outpatients with gastric and colorectal cancer? Nutr Hosp. 2013;28:585–91.
Dias Rodrigues V, Barroso de Pinho N, Abdelhay E, Viola JP, Correia MI, Brum Martucci R. Nutrition and immune-modulatory intervention in surgical patients with gastric cancer. Nutr Clin Pract. 2017;32(1):122-9.
Fukuda Y, Yamamoto K, Hirao M, Nishikawa K, Maeda S, Haraguchi N, et al. Prevalence of malnutrition among gastric cancer patients undergoing gastrectomy and optimal preoperative nutritional support for preventing surgical site infections. Ann Surg Oncol. 2015;22(3):778-85.
Lustosa SA, Saconato H, Atallah ÁN, Lopes Filho GD, Matos D. Impact of extended lymphadenectomy on morbidity, mortality, recurrence and 5-year survival after gastrectomy for cancer: meta-analysis of randomized clinical trials. Acta Cirurgica Brasileira. 2008;23(6):520-30.
Van Cutsem E, Van de Velde C, Roth A, Lordick F, Köhne CH, Cascinu S, et al. Expert opinion on management of gastric and gastro-oesophageal junction adenocarcinoma on behalf of the European Organisation for Research and Treatment of Cancer (EORTC)-gastrointestinal cancer group. Eur J Cancer. 2008;44(2):182-94.
Yang SH, Zhang YC, Yang KH, Li YP, He XD, Tian JH, et al. An evidence-based medicine review of lymphadenectomy extent for gastric cancer. Am J Surg. 2009;197(2):246-51.
Piso P, Bellin T, Aselmann H, Bektas H, Schlitt HJ, Klempnauer J. Results of combined gastrectomy and pancreatic resection in patients with advanced primary gastric carcinoma. Diges Surg. 2002;19(4):281-5.
Jiang N, Deng JY, Ding XW, Ke B, Liu N, Zhang RP, et al. Prognostic nutritional index predicts postoperative complications and long-term outcomes of gastric cancer. World J Gastroenterol. 2014;20(30):10537.
Shim H, Cheong JH, Lee KY, Lee H, Lee JG, Noh SH. Perioperative nutritional status changes in gastrointestinal cancer patients. Yonsei Med J. 2013;54(6):1370-6.
Ajani JA, D'Amico TA, Almhanna K, Bentrem DJ, Chao J, Das P, et al. Gastric cancer, version 3. 2016, NCCN clinical practice guidelines in oncology. J National Comprehen Cancer Network. 2016;14(10):1286-312.
Baker JP, Detsky AS, Wesson DE, Wolman SL, Stewart S, Whitewell J, et al. Nutritional assessment: a comparison of clinical judgment and objective measurements. New England J Med. 1982;306(16):969-72.
Weimann A, Braga M, Harsanyi L, Laviano A, Ljungqvist O, Soeters P, et al. ESPEN guidelines on enteral nutrition: surgery including organ transplantation. Clinical Nutr. 2006;25(2):224-44.
Japanese Gastric Cancer Association. Japanese gastric cancer treatment guidelines 2010 (version 3). Gastric Can. 2011;14(2):113-23.
Dindo D, Demartines N, Clavien PA. Classification of surgical complications: a new proposal with evaluation in a cohort of 6336 patients and results of a survey. Ann Surg. 2004;240(2):205.
Bonenkamp JJ, Songun I, Welvaart K, van de Velde CJ, Hermans J, Sasako M, et al. Randomised comparison of morbidity after D1 and D2 dissection for gastric cancer in 996 Dutch patients. Lancet. 1995;345(8952):745-8.
Bonenkamp JJ, Hermans J, Sasako M, Welvaart K, Songun I, Meyer S, et al. Extended lymph-node dissection for gastric cancer. New England J Med. 1999;340(12):908-14.
Cuschieri A, Joypaul V, Fayers P, Cook P, Fielding J, Craven J, et al. Post-operative morbidity and mortality after D1 and D2 resections for gastric cancer: preliminary results of the MRC randomised controlled surgical trial. Lancet. 1996;347(9007):995-9.
Songun I, Putter H, Kranenbarg EM, Sasako M, van de Velde CJ. Surgical treatment of gastric cancer: 15-year follow-up results of the randomised nationwide Dutch D1D2 trial. Lancet Oncol. 2010;11(5):439-49.
Zheng HL, Lu J, Zheng CH, Li P, Xie JW, Wang JB, et al. Short-and long-term outcomes in malnourished patients after laparoscopic or open radical gastrectomy. World J Surg. 2018;42(1):195-203.
Spolverato G, Ejaz A, Kim Y, Squires MH, Poultsides GA, Fields RC, et al. Rates and patterns of recurrence after curative intent resection for gastric cancer: a United States multi-institutional analysis. J Am Coll Surgeons. 2014;219(4):664-75.
Sunil BJ, Seshadri RA, Mahajan V, Ellusami HR. Postoperative Morbidity and Mortality Following D2 Gastrectomy-an Audit of 456 Cases. Indian J Surg Oncol. 2016;7(1):4-10.
Franklyn J, George SV, Yacob M, Abraham V, Chandran S, Sebastian T, et al. Surgical Outcomes Associated with Operable Gastric Cancer in a Tertiary Care Indian Hospital. J Gastric Can. 2017;17(1):63-73.
El-Fayoumi TA, Fyed HM, El Mesiry M, Awad AT. The applicability of D2 gastrectomy in operable gastric cancer patients: A trial of Alexandria Surgical Oncology Unit. Alexandria J Med. 2013;49(1):229-34.
Gavazzi C, Colatruglio S, Sironi A, Mazzaferro V, Miceli R. Importance of early nutritional screening in patients with gastric cancer. Br J Nutr. 2011;106(12):1773-8.
Rey-Ferro M, Castaño R, Orozco O, Serna A, Moreno A. Nutritional and immunologic evaluation of patients with gastric cancer before and after surgery. Nutrition. 1997;13(10):878-81.
Roy M, Bhutia T, Banerjee S, Thambudorai R, Roy P, Dabkara D, et al. Feasibility of D2 Gastrectomy in Eastern India: Early Results. Clin Oncol. 2017;29(3):82.
Jin LX, Moses LE, Yan Y, Squires MH, Weber SM, Bloomston M, et al. The effect of postoperative morbidity on survival after resection for gastric adenocarcinoma: Results from the US Gastric Cancer Collaborative. J Clin Oncol. 2014;32(3):5.
Shrikhande SV, Shukla PJ, Qureshi S, Siddachari R, Upasani V, Ramadwar M, et al. D2 lymphadenectomy for gastric cancer in Tata Memorial Hospital: Indian data can now be incorporated in future international trials. Digestive surgery. 2006;23(3):192-7.
Roy M, Bhutia T, Banerjee S, Thambudorai R, Roy P, Dabkara D, et al. Feasibility of D2 Gastrectomy in Eastern India: Early Results. Clinical Oncology. 2017;29(3):e82.
Bhandare MS, Kumar NA, Batra S, Chaudhari V, Shrikhande SV. Radical gastrectomy for gastric cancer at Tata Memorial Hospital. Indian J Cancer. 2017;54(4):605.
