A Study of Total Gastrectomy for Gastric Carcinoma in the Aged

Kunio Sakuramoto, Kunio Okajima, Shinichi Yamada, Hiroshi Isozaki, Hitoshi Mizutani, Tatsuhiro Nakajima, Eiji Nakata, Junkou Nishimura, Manabu Honda, Katsumi Amioka, Masanao Kobayashi, Yasuo Kawashima

Department of Surgery, Osaka Medical College

In 56 patients aged over 70 years with gastric carcinoma who were treated by total gastrectomy, we examined the relationship of the incidence of complications and hospital mortality rate to preoperative test results (the number of abnormal test items), the degree of cancer advance (stage, P factor, H factor) and surgical stress (R number, number of combined resections with other organs, thoracotomy, amount of blood loss, and time required for the operation). Of all patients, 23.2% developed complications and 17.9% died in the hospital. Major complications include anastomotic leakage, ileus and myocardial infarction. The major causes of death were respiratory and cardiac failure. Preoperative test results, cancer stage and surgical stress did not correlate with the incidence of complications. However, the incidence of complications was significantly higher in P (+) or H (+) cases than in Po or Ho cases. As a rule, elderly patients with gastric carcinoma should be treated with a curative operation by total gastrectomy accompanied by R2 or more extensive lymph node dissection (including dissection of the para-aortic lymph nodes) and excision of other affected organs. However, the results from this study indicate that total gastrectomy is not indicated in P (+) or H (+) cases.

Key words
gastric carcinoma in the aged, total gastrectomy, incidence of complications, hospital mortality

Reprint requests
Kunio Sakuramoto Department of Surgery, Osaka Medical College
2-7 Daigaku-cho, Takatsuki, 569 JAPAN

Accepted
February 13, 1991

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