Abstract
Aim: Prospective studies were conducted to improve hospital mortality for gastrectomy in stomach cancer patients by assessing risk factors for hospital death. Subjects: Subjects were 690 patients from 1991 to 2000 who underwent gastrectomy for gastric cancer at our department of surgery. The first 6 years of research (1991-1996) were analyzed to find risk factors for hospital death retrospective by and the next 4 years de-voted to prospective study (1997-2000) to verify risk factors for hospital death revealed by the retrospective study. Results: Hospital mortality was 6.7%(46 subjects; 32 men and 14 women averaging 65±9 years of age) during the first 6 years. Patients dying surgery numbered 13 cases with an average hospital stay of 33±60 days. Total-gastrectomy deaths numbered 24 (11%). Distal-gastrectomy deaths numbered 18 (5.3%). Gasro-enterostomy deaths numbered 2 in hospital. Exploratory lobotomy deaths numbered 2 in hospital. Ten-tative risk factors for hospital death in surgery were thus, 1) pre-operative complications with poor perform-ance status, 2)<40 of the PNI nutrition index before operation, 3) cases for the neo-adjuvant chemotherapy, 4) cases with data of over twice much for tumor markers or cases with elevation of the FDP, 5) supposed cura-tive C (no curativity for gastric cancer) operation. Strict indications for operation (no more than 2 risk factors as shown in above criteria) contributed to the improvement for hospital death rate in next period of the study subjects. Highest death causes for the hospital death was carcinomatosis, numbered 19 (45%) in first period and 6 (67%) in second period, respectively and post operative complications were the second causes, num-bered 22 (52%) in first period and 2 (20%) in seconds period. Avoidance for the operation in patients with potential operative complications and potential operative carcinomatosis (possible curative C patients) led bet-ter survivals. Conclusions: The selection of indications for gastrectomy depending on risk factors helps the decrease hospital death. Further reducing hospital death requires the introduction of scoring for risk assess-ment of operative indications or pre operative procedures.
