Reoperation for early postoperative complications after gastric cancer surgery in a Chinese hospital

Table 1 Demographic data of the patients

Items	Percentage (%)
Age group (yr)
≤ 60	54.1
61-70	25.2
≥ 71	20.7
Sex
Male	68.9
Female	31.1
Diagnosis
Primary gastric cancer	97.4
Gastric stump cancer1	2.6
Site of tumor
Proximal	17.6
Body	13.5
Distal	43.3
Large or multiple	25.6
No. of procedures
Partial gastrectomy	76.0
Total gastrectomy	24.0
Type of resection
Radical gastrectomy	91.6
Palliative gastrectomy	8.4
Combined resection
Yes	4.4
No	95.6
Type of anastomosis
Billroth I	47.6
Billroth II	13.9
Billroth reverse2	13.4
Roux-en-Y	21.6
Roux-en-Y (P-shape)	3.0
Others	0.5
Unknown	0.3
TNM stage
IA	12.1
IB	8.5
II	18.1
IIIA	20.8
IIIB	16.2
IV	24.3

¹Including recurrent gastric cancer;

²Oesophago-gastric anastomosis.

Table 2 Details of complications

Complications	Frequency	Percentage (%)
Hemorrhage
Wound	1	0.1
Deep	16	1.0
Wound dehiscence
Superficial	9	0.5
Deep	5	0.3
Anastomotic leak	38	2.3
Infection
Wound	15	0.9
Deep	80	4.9
Pyrexia of unknown origin	253	15.4
Septicemia	7	0.4
Chest	172	10.5
Urinary tract infection	20	1.2
System failure
Renal	28	1.7
Respiratory	22	1.3
Cardiac	13	0.8
Hypotension	16	1.0
Deep venous thrombosis	4	0.2
Death	17	1.0
Overall	506	30.9

Table 3 Innominate complications

Complications	Frequency	Percentage (%)
Pleural effusion	213	13
Continuous or relapsing pyrexia of unknown origin	170	10.4
Seroperitoneum	118	7.2
Gastro or enteroplegia, anastomosis edema, ileus	75	4.6
Suspicious or sub-clinical anastomotic leak	57	3.5
Pancreatitis	22	1.3
Central vein catheter infection	14	0.9
Anastomosis site or upper GI bleeding	10	0.6
Chyle leak	8	0.5
Pancreatic fistula	6	0.4

Table 4 Difference of complication rate between partial and total gastrectomy

LN dissection	Radical			Palliative
Gastrectomy	Partial	Total	Sig	Partial	Total	Sig
Overall	308 (26.7)	142 (40.9)	< 0.001	32 (34.8)	24 (52.2)	NS
Reoperation	23 (2.0)	12 (3.5)	NS	1 (1.1)	0	NS
Hemorrhage
Wound	1 (0.1)	0	NS	0	0
Deep	11 (1.0)	4 (1.2)	NS	1 (1.1)	0	NS
Wound dehiscence
Superficial	7 (0.6)	1 (0.3)	NS	1 (1.1)	0	NS
Deep	4 (0.3)	1 (0.3)	NS	0	0
Leak	22 (1.9)	12 (3.5)	NS	1 (1.1)	3 (6.5)	NS
Infection
Wound	8 (0.7)	6 (1.7)	NS	1 (1.1)	0	NS
Deep	42 (3.6)	30 (8.6)	< 0.001	5 (5.4)	3 (6.5)	NS
PUO	165 (14.3)	65 (18.7)	0.044	13 (14.1)	10 (21.7)	NS
Septicemia	1 (0.1)	6 (1.7)	< 0.001	0	0
Chest	86 (7.5)	61 (17.6)	< 0.001	14 (15.2)	11 (23.9)	NS
UTI	13 (1.1)	6 (1.7)	NS	1 (1.1)	0	NS
System failure
Renal	15 (1.3)	12 (3.5)	0.008	1 (1.1)	0	NS
Respiratory	12 (1.0)	7 (2.0)	NS	3 (3.3)	0	NS
Cardiac	5 (0.4)	6 (1.7)	0.034	2 (2.2)	0	NS
Hypotension	8 (0.7)	6 (1.7)	NS	2 (2.2)	0	NS
DVT	1 (0.1)	3 (0.9)	NS	1 (1.1)	0	NS
Death	6 (0.5)	8 (2.3)	0.007	2 (2.2)	1 (2.2)	NS

Sig: Significance; LN: Lymph node; PUO: Pyrexia of unknown origin; UTI: Urinary tract infection; DVT: Deep vein thrombosis.

Table 5 Difference of complications rate between radical and palliative LN dissection

LN dissection	Partial			Total
Gastrectomy	Radical	Palliative	Sig	Radical	Palliative	Sig
Overall	308 (26.7)	32 (34.8)	NS	142 (40.9)	24 (52.2)	NS
Reoperation	23 (2.0)	1 (1.1)	NS	12 (3.5)	0	NS
Hemorrhage
Wound	1 (0.1)	0	NS	0	0	NS
Deep	11 (1.0)	1 (1.1)	NS	4 (1.2)	0	NS
Wound dehiscence
Superficial	7 (0.6)	1 (1.1)	NS	1 (0.3)	0	NS
Deep	4 (0.3)	0	NS	1 (0.3)	0	NS
Leak	22 (1.9)	1 (1.1)	NS	12 (3.5)	3 (6.5)	NS
Infection
Wound	8 (0.7)	1 (1.1)	NS	6 (1.7)	0	NS
Deep	42 (3.6)	5 (5.4)	NS	30 (8.6)	3 (6.5)	NS
PUO	165 (14.3)	13 (14.1)	NS	65 (18.7)	10 (21.7)	NS
Septicemia	1 (0.1)	0	NS	6 (1.7)	0	NS
Chest	86 (7.5)	14 (15.2)	0.008	61 (17.6)	11 (23.9)	NS
UTI	13 (1.1)	1 (1.1)	NS	6 (1.7)	0	NS
System failure
Renal	15 (1.3)	1 (1.1)	NS	12 (3.5)	0	NS
Respiratory	12 (1.0)	3 (3.3)	NS	7 (2.0)	0	NS
Cardiac	5 (0.4)	2 (2.2)	NS	6 (1.7)	0	NS
Hypotension	8 (0.7)	2 (2.2)	NS	6 (1.7)		NS
DVT	1 (0.1)	1 (1.1)	NS	3 (0.9)	0	NS
Death	6 (0.5)	2 (2.2)	NS	8 (2.3)	1 (2.2)	NS

Table 6 Causes of reoperation

Causes	Surgical management	Frequency
Intra-abdominal hemorrhage1	Simple hemostasis	16
Anastomotic leak	Repair and placement of drainage	10
Deep wound dehiscence	Closure of abdominal wall	4
Abdominal infection	Debridement and placement of drainage	3
Ileus	Adhesiolysis of small intestine	2
Anastomotic obstruction	Reconstruction	1

¹Including 2 cases of anastomosis site bleeding.

Table 7 Potential causes of death

Complications	Reoperation n (%)
	Yes (n = 36)	No (n = 1603)
Death	4 (11.11)	13 (0.81)
Extent of surgery
LN dissection
Radical	4 (11.11)	10 (0.62)
Palliative	0	3 (0.18)
Gastrectomy
Partial	1 (0.03)	7 (0.44)
Total	3 (8.33)	6 (0.37)
Complications
Intra abdominal hemorrhage	1 (0.03)	0
Anastomotic leak	2 (5.55)	0
Infection
Deep	1 (0.03)	2 (0.12)
Pyrexia of unknown origin	0	3 (0.18)
Septicemia	0	1 (0.06)
Chest	3 (8.33)	7 (0.44)
Urinary tract	2 (5.55)	0
System failure
Renal	3 (8.33)	8 (0.49)
Respiratory	4 (11.11)	10 (0.62)
Cardiac	2 (5.55)	9 (0.56)
Hypotension	1 (0.03)	9 (0.56)
Deep venous thrombosis	0	3 (0.18)
Pancreatitis	0	1 (0.06)
Anastomosis site bleeding	0	1 (0.06)