Investigation of Postoperative Ileus after Gastrectomy and Prevention of Ileus by Limited Surgery for Early Gastric Cancer

Atsushi Nashimoto, Tetsuya Morota, Hiroshi Yabusaki, Yoshiaki Tsuchiya, Otsuo Tanaka and Juei Sasaki

Division of Surgery, Niigata Cancer Center Hospital

The results of postoperative intestinal obstruction (ileus) after various surgical procedures in gastric cancer patients (pts) were evaluated and prevention of ileus by limited surgery for early gastric cancer pts was considered. In this study, 2,314 pts who underwent gastrectomy from 1987 to 1996, were included if they required hospital treatment, excluding relapsed pts. Of 121 ileus pts (5. 2%), 60 pts underwent surgery for postoperative ileus. The mean number of admissions for ileus was 1. 8 times (1 to 10 times), and surgery for ileus was performed on 59. 0%of the pts within one year and 85. 2% within 3 years after gastrectomy. The main surgical procedures were lysis (63. 4%) and partial resection of small bowel (33. 3%). The frequency of ileus was 6. 2% after total gastrectomy, 5.1% after distal gastrectomy, 9.1% after proximal gastrectomy and 0% (0/107) after partial gastrectomy. Furthermore, the frequency of ileus was lower after D0, 1 lymph node dissection than D2-dissection, and also lower after omentum preserving procedure than omentumectomy. But there was no difference in long-term survival of early gastric cancer pts after distal gastrectomy between D0, 1 and D2-lymph node dissection, and between omentum preserving procedure and omentumectomy. In conclusion, the incidence of ileus after gastrectomy proved to be lower in minimally invasive surgery, such as partial stomach resection, limited lymph node dissection and omentum preserving procedure. These techniques for early gastric cancer pts seem to improve the quality of life after surgery and to prevent the occurrence of postoperative ileus without worsening long-term survival.

Key words
ileus after gastrectomy, limited surgery for early gastric cancer, omentum preserving procedure for early gastric cancer, lymph node dissection for early gastric cancer

Reprint requests
Atsushi Nashimoto Division of Surgery, Niigata Cancer Center Hospital 2-15-3 Kawagishicho, Niigata, 951-8566 JAPAN

Accepted
April 26, 2000

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