Improvements in Operative Morbidity and Mortality for Gastrectomy in Stomach Cancer Patients by Risk Assessments for Causes for Hospital Mortality

Shunji Kato, Norio Matsukura, Hiroyuki Onodera, Takeshi Okuda, Takashi Mizutani, Teruo Kiyama, Toshiro Yoshiyuki, Itsurou Fujita, Akira Tokunaga* and Takashi Tajiri

Surgery for Organ Function and Biological Regulation, Nippon Medical School and Nippon Medical School Second Branch Hospital*

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 devoted 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. Tentative risk factors for hospital death in surgery were thus, 1) pre-operative complications with poor performance 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 curative 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, numbered 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 better 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 assessment of operative indications or pre operative procedures.

Key words
hospital mortality, gastric cancer, operation, morbidity, mortality

Reprint requests
Shunji Kato 1st Department of Surgery, Nippon Medical School
1-1-5 Sendagi, Bunkyo-ku, 113-8603 JAPAN

Accepted
December 17, 2004

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