Treatment and Results of Serious Complications Following Anastomotic Leakage after Gastrectomy for Gastric Cancer

Abstract

Anastomotic leakage occurred in 66 (9.1%) out of 724 patients who underwent gastrectomy for gastric cancer, 13 of these patients (19%) developed serious complications, including organ failure and/or massive intracorporeal bleeding. All the patients with serious complications had undergone a total gastrectomy, and most of them had stage III or IV tumors, had undergone D2-D3 lymph node dissection, and had received a combined resection of the pancreas or spleen or a curative resection. Of these 13 patients, five suffered massive intracorporeal bleeding and were successfully treated and cured by early surgical drainage and emergent hemostatic procedures, including surgical ligature or transarterial embolization (TAE) using interventional radiology. Two of the patients developed bleeding again and required retreatment using TAE and surgical drainage. The other eight patients suffered organ failure (5, respiratory; 1, renal; and 2, multiple organs). Six of these patients were cured by surgical drainage and adequate therapy for the specific organ failure, such as mechanical ventilation or renal dialysis. However, the other two patients who had a high operative risk and stage III or IV tumors died in hospital of multiple organ failure from the sepsis of a herpes zoster infection or grave aspiration pneumonia. The present results suggested that most patients with serious complications following anastomotic leakage can be cured by prompt and adequate treatment. However, to prevent the complications, safe and adequate operations should be performed based on a precise assessment of the tumor stage and the patient's preoperative condition.