Is the rate of postoperative complications following laparoscopy-assisted gastrectomy higher in elderly patients than in younger patients?

BACKGROUND: With an increase in life expectancy, very elderly patients are presenting with gastric cancer more commonly than ever. The present study retrospectively analyzed the surgical outcomes of laparoscopy-assisted gastrectomy for gastric cancer in the young, elderly, and very elderly age groups. METHODS: The study group consisted of 1,055 patients who underwent laparoscopy-assisted gastrectomy between February 2002 and December 2012. We divided these patients into three groups; group 1 (young age, <65 years), group 2 (elderly age, 65-74 years), and group 3 (very elderly age, ≥75 years). RESULTS: There were statistical differences in the rates of postoperative complications among the three groups (P = 0.008). However, when assessed according to the severity of postoperative complications based on the Clavien-Dindo classification, there was no statistical difference among the three groups (P = 0.562). CONCLUSIONS: Laparoscopy-assisted gastrectomy for gastric cancer can be performed in very elderly patients. In analyzing studies of elderly patients with postoperative complications following the procedure, not only should the rate of postoperative complications be taken into consideration, but also the severity of any postoperative complications.

Risk factors for duodenal stump leakage after gastrectomy for gastric cancer and management technique of stump leakage.

BACKGROUND/AIMS: The goal of this study was to elucidate the risk factors for duodenal stump leakage after gastrectomy for gastric cancer. In addition, the management of duodenal stump leakage is reviewed. METHODOLOGY: From January 2002 through December 2012, 1,195 patients with gastric cancer who underwent gastric R0 resection were enrolled in this study. The clinicopathologic features, postoperative outcomes (i.e., operation time, hospital stay, surgical procedures, method of duodenal stump closure, retrieved lymph nodes), and the risk factors of duodenal stump leakage were analyzed. RESULTS: Of the 1,195 patients, 13 patients (1.1%) suffered duodenal stump leakage. Most of the patients with duodenal stump leakage were male (92.3%). Nine patients underwent a subtotal gastrectomy with Billroth- II or Roux-en-Y anastomosis; the other four patients underwent a total gastrectomy with a Roux-en-Y anastomosis. There were two mortalities. With univariate and multivariate analysis, age was the most predictable factor for duodenal stump leakage (p= 0.034, p=0.044) CONCLUSIONS: Duodenal stump leakage was affected by the age. For older patients who undergo a radical gastrectomy for gastric cancer, the surgeon must pay meticulous attention to the transection and mobilization of the duodenum in order to prevent duodenal stump leakage.

The differences in clinicopathological features and prognosis among the subtypes of signet ring cell, mucinous, papillary, and lymphoepithelioma-like carcinoma in advanced gastric cancer.

BACKGROUND/AIMS: There are differing histologic subtypes of gastric cancer. We investigated the clinicopathological features and prognosis of: signet ring cell (SRC), mucinous (MGC), papillary (PGC), and lymphoepithelioma-like (LELC) carcinoma in advanced gastric cancer. METHODOLOGY: One hundred thirty six advanced gastric cancer patients, including 62 SRCs, 43 MGCs, 9 PGCs, and 22 LELCs, who underwent R0 gastrectomy between 2002 and 2013, were retrospectively evaluated. RESULTS: There were significant differences in several clinicopathological features. There were found to be statistical differences in postoperative outcomes in the type of gastrectomy and type of anastomosis (p<0.001 and p<0.001, respectively). In terms of overall survival analysis, there was no statistical survival difference among the subtypes of advanced gastric cancer (p=0.088). However, LELC had a better prognosis than the other groups. CONCLUSIONS: There were some differences in several of the clinicopathological features of the subtypes advanced gastric cancer. Although there were no statistical differences in survival, those with LELC showed a better prognosis than did the other groups. Therefore, the treatment of advanced gastric cancer should be individualized, and prognosis considered, according to the subtype.

Is laparoscopy-assisted total gastrectomy feasible for the treatment of gastric cancer? A case-matched study.

BACKGROUND: The aim of this study was to clarify the short- and long-term outcomes of laparoscopy-assisted total gastrectomy (LATG) for gastric cancer compared to conventional open total gastrectomy (COTG) with a case-control study. METHODS: Between January 2002 and December 2010, a series of 264 patients with gastric cancer underwent R0 total gastrectomy (61 LATG patients and 203 COTG patients). Age, gender, and pathological stage were matched by propensity scoring, and 120 patients (60 LATG and 60 COTG) were selected for analysis. RESULTS: There were no significant differences in the clinicopathological features between the two groups. Regarding postoperative outcomes, first flatus time was significantly shorter in the LATG group than in the COTG group (p < 0.001), while operation time was significantly longer in the LATG group than in the COTG group (p < 0.001). Postoperative complications occurred in 5 cases (8.3%) of the LATG group and in 11 cases (18.3%) of the COTG group (p = 0.178). There were two recurrences in the LATG group and three recurrences in the COTG group. There was no significant difference in the 5-year survival rate between the two groups (p = 0.667). CONCLUSIONS: LATG for gastric cancer may be both feasible and efficient compared to COTG for experienced laparoscopic surgeons. This study is valuable for a prospective randomized controlled trial of LATG for gastric cancer in a larger number of patients.

A 5 year analysis of readmissions after radical subtotal gastrectomy for early gastric cancer.

BACKGROUND: Many patients and surgeons have become interested in the quality of life after surgery for early gastric cancer. However, no reports on readmission rates for gastrectomy patients have been published, even if readmission greatly affects the patient's quality of life. METHODS: In 530 consecutive early gastric cancer patients who underwent radical subtotal gastrectomy, we determined the incidence, cause, timing, type of treatment, and risk factors for readmission after discharge, and compared the readmission and nonreadmission groups with respect to clinicopathologic features and postoperative outcomes. RESULTS: Overall, the 5 year and 1 month readmission rates after radical subtotal gastrectomy for early gastric cancer were 13.0% (69 of 530) and 7.5% (40 of 530), respectively. The most common cause for readmission was delayed gastric emptying (17 cases). Among a total of 82 readmissions, 34 patients (41.5%) were readmitted within 2 weeks of surgery. The type of treatment for 82 readmissions included 55 conservative therapies, 15 radiologic or endoscopic interventions, and 12 repeat laparotomies. No significant differences were detected in the clinicopathologic feature and postoperative outcomes between the two groups. The initial hospital stay remained significantly associated with readmission based on multivariate analysis. CONCLUSIONS: Readmission rate at 1 month after radical subtotal gastrectomy is lower than that after major bowel surgery. Unusual postoperative recovery in a patient with vague symptoms should be managed with greater care before discharge. After subtotal gastrectomy for early gastric cancer, prevention of readmission can improve the patient's quality of life.

Fascin expression is related to poor survival in gastric cancer.

Fascin is an actin-binding protein that provides mechanical support and cell motility, and involves cancer cell metastasis. We investigated fascin protein expression in gastric cancer and assessed their relationship with clinicopathologic parameters and survival rates. In addition, we researched galectin-3 protein expression to study fascin action mechanisms. We performed immunohistochemisty with fascin and galectin-3 antibodies in 471 gastric carcinomas, using tissue microarrays. Fascin was positive in 14.9% (70/471) of the samples, and fascin expression was related to worse survival rates (P < 0.001), high clinical stage (P < 0.001), high T stage (P < 0.001), nodal metastasis (P < 0.001), lymphovascular invasion (P= 0.001) and the intestinal type of Lauren classification (P= 0.015). Galectin-3 protein expression was positive in 83.9% (395/471) of the samples and was reversely correlated with fascin protein expression (P= 0.020). Galectin-3 expression was related to low clinical stage (P < 0.001), but not to survival rates in multivariate analysis. In multivariate analysis, fascin expression was related to worse survival rates (HR = 1.56, P= 0.036), and can be an independent poor prognostic factor in gastric cancer.

Comparative analysis of five-year survival results of laparoscopy-assisted gastrectomy versus open gastrectomy for advanced gastric cancer: a case-control study using a propensity score method.

BACKGROUND: The aim of this study was to investigate the surgical and oncologic outcomes of laparoscopy-assisted gastrectomy (LAG) and open gastrectomy (OG) for advanced gastric cancer (AGC) using the case-control method with a sufficient follow-up period. PATIENTS AND METHODS: The authors retrospectively analyzed 89 patients who underwent LAG and 345 patients who underwent OG for AGC between August 1999 and June 2007. A total of 176 matched cases were included in the final analysis. RESULTS: Except for tumor size and reconstruction, there were no statistically significant differences in the clinicopathological parameters between the two groups. Although operation time was significantly longer for LAG than OG (228.3 vs. 183.6 min, p < 0.0001), first flatus time and postoperative hospital stay without complications were significantly shorter in the LAG group (3.2 vs. 3.7 days, p < 0.0001; 7.0 vs. 10.4 days, p < 0.0001, respectively). Operation-related complications occurred in 7 cases (8.0%) in both groups. 13 patients (14.8%) in the LAG group and 15 patients (17.1%) in the OG group had recurrence. There was no statistically significant difference in the 5-year and disease-free survival rates between LAG and OG. CONCLUSIONS: LAG for AGC might be considered to be a minimally invasive surgery in some selected cases, although a well-designed prospective study comparing LAG with OG for AGC is needed.

Long term survival results for gastric GIST: is laparoscopic surgery for large gastric GIST feasible?

BACKGROUND: Recently, laparoscopic resection for relatively small sized gastric gastrointestinal stromal tumors (GISTs) has been widely accepted as minimally invasive surgery. However, no report on the long-term safety and efficacy of this surgery for large sized gastric GISTs has been published to date. METHODS: Between July 1998 and January 2011, 104 consecutive patients who underwent resection for gastric GISTs were enrolled in this retrospective study. We assessed the clinicopathological characteristics, postoperative outcomes, patient survival, and tumor recurrence. RESULTS: Of the 104 patients with gastric GISTs who were included in the study, there were 47 males and 57 females whose mean age was 59.8 years. Sixty-four patients (61.5%) had symptoms associated with tumor. Ten patients included in the group 1, 49 in the group 2, 15 in the group 3a, 9 in the group 5, 14 in the group 6a, and 7 in the group 6b. There was one minor complication and no mortalities. Recurrence was noted in 5 patients, with a median follow-up period of 49.3 months (range, 8.4 to 164.4). The 5-year overall and disease free survival rates of 104 patients were 98.6% and 94.8%, respectively. When comparing large tumor (5-10 cm) between laparoscopic and open surgery, there were statistically differences in age, tumor size, tumor location, and length of hospitalization. There were no statistical differences in the 5-year survival rate between laparoscopic and open surgery for large tumor (5-10cm). CONCLUSION: Laparoscopic surgery is feasible and effective as an oncologic treatment of gastric GISTs. Moreover, laparoscopic surgery can be an acceptable alternative to open methods for gastric GISTs of size bigger than 5 cm.

Comparing of the results between single port and three ports in laparoscopic cholecystectomy.

BACKGROUND/AIMS: The aim of this prospective trial was to observe the results of the two types of techniques. METHODOLOGY: Single port laparoscopic cholecystectomy (SPLC) (56 cases) indication was polyp disease and mild cholecystitis with gall bladder stone (no right upper quadrant tenderness in physical examination, no gall bladder wall thickening in image study). Three ports laparoscopic cholecystectomy (TPLC) (46 cases) was applied to previous laparoscopic surgery indication. There were slight differences in indication as there are still limitations in applying single port laparoscopic cholecystectomy in all patients. RESULTS: The two groups were similar with respect to demographic characteristics. There were no significant differences in operation time, bile leakage during operation, postoperative hospital stay, pain score. Additional port(s) use in single port laparoscopic cholecystectomy were 13 cases, the reasons were difficult dissection of Calot's triangle (7 cases), incomplete ligation by Hem-o-lok clip (3 cases), cystic artery bleeding (3 cases), difficult visual due to obesity (1 case). CONCLUSIONS: Single port laparoscopic cholecystectomy is still in its initial stages. Although many controversies remain regarding stability and possibility, it is believed that development and exchange of new instruments and techniques will form an important part of future minimal invasive surgery.

Application of an endo-GIA for ligation of the cystic duct during difficult laparoscopic cholecystectomy.

BACKGROUND/AIMS: Laparoscopic cholecystectomy has become the gold standard modality for treating gallbladder disease. There are many techniques for the ligation of a dilated and inflamed cystic duct. The aim of this study is to assess the efficacy and applicability of an Endo-GIA for dilated cystic duct ligation. METHODOLOGY: From October 1992 to September 2009, 3413 patients underwent laparoscopic cholecystectomy for gallbladder disease at the Dong-A Medical Center, and 92 (2.7%) patients' cystic ducts were ligated by an Endo-GIA. We retrospectively analyzed these 92 cases. RESULTS: The cystic ducts were successfully ligated with an Endo-GIA in 88 patients. Four patients required conversion to open surgery. The mean operation time was 111.9 minutes. The mean length of the hospital stay was 4.1 days. Postoperative complication occurred in 16 patients (17%). The follow-up period ranged from 0.5 to 75 months. CONCLUSIONS: Endo-GIA is safe and feasible. Postoperative complication occurred in 16 patients after application of an Endo-GIA. However, those complications were successfully managed by conservative treatment. The rate of complications was comparable to the best results from most of the large series in the West. Therefore, using an Endo-GIA could be attempted in carefully selected patients with difficult cases of laparoscopic cholecystectomy.

Robotic gastrectomy for gastric cancer: surgical techniques and clinical merits.

BACKGROUND: Robotic gastrectomy in the setting of gastric cancer is reported by some investigators. However, no study has compared robotic surgery with open or laparoscopic surgery for patients with gastric cancer. This study aimed to determine the clinical benefits of robotic gastrectomy over open and laparoscopic gastrectomy for the treatment of gastric cancer. METHODS: After the introduction of the da Vinci surgical system in November 2007 at the authors' hospital, 18 robotic gastrectomies were performed from 31 December 2007 to 30 June 2008. The prospective data from gastric cancer patients who underwent gastrectomies (16 robotic, 11 laparoscopic, and 12 open) during the same period were retrospectively analyzed. RESULTS: Sex, age, comorbidity, extent of lymphadenectomy, pT stage, lymph node metastasis, and number of lymph nodes retrieved were similar among the three groups. The estimated blood loss was significantly less in the robotic gastrectomy group than in the open group (p = 0.0312), and the postoperative hospital stay in the robotic group was significantly shorter than in the open and laparoscopic gastrectomy groups (p < 0.001). Postoperative morbidity and time to first flatus were similar in the three groups. There was no open or laparoscopic conversion in the robotic group. No postoperative mortality occurred in any group. CONCLUSION: Robotic gastrectomy for the treatment of gastric cancer is a feasible and safe procedure in the hands of experienced laparoscopic surgeons. Robotic gastrectomy offers better short-term surgical outcomes than the open and laparoscopic methods. Furthermore, this procedure may be a preferable alternative for the treatment of gastric cancer.

Early detection of recurrence after endoscopic treatment for early gastric cancer.

OBJECTIVE: Although there have been many reports regarding clinical outcomes of endoscopic treatment for early gastric cancer (EGC), little is known about detection of recurrence after endoscopic submucosal dissection (ESD). This study aims to clarify the clinical value of serological marker or imaging tools, including conventional CT and PET-CT scans, in detecting recurrent gastric cancer after ESD in Korea. MATERIAL AND METHODS: From July 2004 to March 2008, 212 patients who had received ESD for EGC were enrolled in the study. For preoperative staging, conventional CT and PET-CT scans were performed in 141 patients, and for detection of recurrence of cancer, conventional CT, PET-CT scans and tumour marker; CEA, CA19-9, AFP were checked in 165 patients. RESULTS: The local recurrence rate was 4.7% (10/212) during the study period. At 9 months after endoscopic treatment, 3 cases recurred. Four showed recurrence at 12 months, 2 at 18 months and 1 at 24 months. The positive rate was 7.1% (10/141) in conventional CT and 0% (0/24) in PET-CT scans for preoperative staging. Conventional CT and PET-CT scans could not detect local recurrence of cancer during the follow-up period. Tumour markers did not show any significant correlation with recurrence of cancer. CONCLUSIONS: The study suggests that conventional CT, PET-CT scans and tumour marker have no role in the primary surveillance of early gastric cancer and/or in detecting recurrence after endoscopic treatment. For early diagnosis of recurrence after endoscopic treatment, a biopsy specimen from the endoscopic examination has to be obtained at regular intervals.

Cellular and peritoneal immune response after radical laparoscopy-assisted and open gastrectomy for gastric cancer.

BACKGROUND AND OBJECTIVES: The aim of this study was to assess cellular and peritoneal immune responses after radical laparoscopic surgery in gastric cancer. METHODS: Peripheral heparinized plasma and plain serum tube samples were collected preoperatively, and at 2 hr, 1 day, and 4 days postoperatively for analysis o; white blood cells, total lymphocytes, T-helper lymphocytes, T-suppressor lymphocytes, B-lymphocytes, natural killer cells, plasma C-reactive protein and serum amyloid-A. Twenty-four hours peritoneal fluid collection was performed on days 1 and 4 for TNF-alpha, IL-6, and IL-10 analysis. RESULTS: No statistical differences were observed between the two groups with respect to immunocompetent cell counts. The serum levels of plasma CRP and SAA gradually increased significantly with time in both groups, but these temporal increases were lower in the LADG group (CRP; P = 0.03, SAA; P = 0.01). Peritoneal TNF-alpha levels in the CODG group at 4 days postoperatively were significantly higher than at day 1, but remained almost unchanged in the LADG group, and this difference was significant (P = 0.02). CONCLUSION: Because of its association with reduced peritoneal immune activity, laparoscopic surgery for advanced gastric cancer may require careful consideration in practice. Additional, larger prospective multicenter trials are required before a consensus can be reached.

The clinicopathologic and immunohistochemical characteristics of ampulla of Vater carcinoma: the intestinal type is associated with a better prognosis.

BACKGROUND/AIMS: We wanted to compare the clinicopathological parameters with the immunohistochemical expression patterns and patient survival for the intestinal type (IT) and the pancreatobiliary type (PT) of ampulla of Vater carcinoma. Ampulla of Vater carcinoma can be classified histologically into either IT or PT. The biologic behavior and patient prognosis vary considerably in relation to the tumor type. METHODOLOGY: From September, 1995, to February, 2004, 34 patients with the pathologic diagnosis of ampulla of Vater carcinoma were retrospectively reviewed and the prognostic factors were analyzed. To classify the phenotypes of the tumors, the keratin types (CK7 and CK20), the type of apomucin of the mucosa (MUC2), and the glucose transporter (GLUT1) were studied for differentiating the tumor types. RESULTS: The 5-year survival rate of the 34 patients with ampulla of Vater carcinoma was 58.8%. Histologically, 12 patients had IT and 22 had PT, and the IT patients all survived. The long-term survival after resection of the tumor was significantly greater for the patients with IT than for the patients with PT. Although these differences were not statistically significant, the prognosis of IT group seemed more favorable (p = 0.0955). On the immunohistochemical staining, MUC2 (p < 0.0001), CK20 (p = 0.0002) and CK7 (p = 0.0368) were statistically effective, but not GLUT1, for differentiating IT from PT. CONCLUSIONS: For the classification of the tumor phenotypes, performing immunohistochemical staining were helpful to differentiate the two types of tumor. A study with a larger number samples would probably elucidate the different clinical course between these two types of ampulla of Vater carcinoma.

Traumatic abdominal wall hernia (TAWH): a case study highlighting surgical management.

We report a rare case of traumatic abdominal wall hernia (TAWH) caused by a traffic accident. A 47-year-old woman presented to the emergency room soon after a traffic accident. She complained of diffuse, dull abdominal pain and mild nausea. She had no history of prior abdominal surgery or hernia. We found a bulging mass on her right abdomen. Plain abdominal films demonstrated a protrusion of hollow viscus beyond the right paracolic fat plane. Computed tomography (CT) showed intestinal herniation through an abdominal wall defect into the subcutaneous space. She underwent an exploratory surgery, followed by a layer-by-layer interrupted closure of the wall defect using absorbable monofilament sutures without mesh and with no tension, despite the large size of the defect. Her postoperative course was uneventful.

Laparoscopic management of a primary small bowel volvulus: a case report.

Primary small bowel volvulus in adults is a very rare condition, and it is defined as torsion of all or a large segment of the small intestine and its mesentery in the absence of any preexisting etiologic factors. Proper management of the patients suffering from a strangulated obstruction depends on making an early and accurate diagnosis. Timely treatment is crucial to prevent gangrene. A 49-year-old man who had a history of previous abdominal surgery was admitted to our hospital with complaints of acute abdominal pain. Simple abdominal x-ray showed multiple dilated loops of small intestine in the mid-abdomen. Enhanced abdominal computed tomography showed the distended small bowel loops and longitudinal tapering of the collapsed bowel loops. We carried out diagnostic laparoscopy to confirm the cause of suspected mechanical ileus. It revealed strangulation of the small bowel at the terminal ileum due to clockwise torsion of the bowel loop. There were no adhesions or congenital anomalies in the peritoneal cavity. The torsional segment was spontaneously reduced with minimal handling, and the strangulated portion was resected. The patient was discharged from hospital on postoperative day 6. Primary small bowel volvulus in adults is a very rare malady; if the diagnosis is uncertain, then diagnostic laparoscopy is a valuable tool for making the definitive diagnosis and administering prompt treatment.

Pilot study of postoperative adjuvant chemoradiation for advanced gastric cancer: adjuvant 5-FU/cisplatin and chemoradiation with capecitabine.

AIM: To evaluate the efficacy and toxicity of postoperative chemoradiation using FP chemotherapy and oral capecitabine during radiation for advanced gastric cancer following curative resection. METHODS: Thirty-one patients who had underwent a potentially curative resection for Stage III and IV (M0) gastric cancer were enrolled. Therapy consists of one cycle of FP (continuous infusion of 5-FU 1000 mg/m(2) on d 1 to 5 and cisplatin 60 mg/m(2) on d 1) followed by 4500 cGy (180 cGy/d) with capecitabine (1650 mg/m(2) daily throughout radiotherapy). Four wk after completion of the radiotherapy, patients received three additional cycles of FP every three wk. The median follow-up duration was 22.2 mo. RESULTS: The 3-year disease free and overall survival in this study were 82.7% and 83.4%, respectively. Four patients (12.9%) showed relapse during follow-up. Eight patients did not complete all planned adjuvant therapy. Grade 3/4 toxicities included neutropenia in 50.2%, anemia in 12.9%, thrombocytopenia in 3.2% and nausea/vomiting in 3.2%. Neither grade 3/4 hand foot syndrome nor treatment related febrile neutropenia or death were observed. CONCLUSION: These preliminary results suggest that this postoperative adjuvant chemoradiation regimen of FP before and after capecitabine and concurrent radiotherapy appears well tolerated and offers a comparable toxicity profile to the chemoradiation regimen utilized in INT-0116. This treatment modality allowed successful loco-regional control rate and 3-year overall survival.

Gastric cancer occurring in a patient with Plummer-Vinson syndrome: a case report.

Plummer-Vinson syndrome (sideropenic dysphagia) is characterized by dysphagia due to an upper esophageal or hypopharyngeal web in patients with chronic iron deficiency anemia. The main cause of dysphagia is the presence of the web in the cervical esophagus, and abnormal motility of the pharynx or esophagus is also found to play a significant role in this condition. This syndrome is thought to be precancerous because squamous cell carcinoma of hypopharynx, oral cavity or esophagus takes place in 10% of those patients suffering from this malady, but it is even more unusual that Plummer-Vinson syndrome should be accompanied by gastric cancer. We have reported here a case of a 43-year-old woman with Plummer-Vinson syndrome who developed stomach cancer and recovered after a radical total gastrectomy with D2 nodal dissection.

Learning curve of laparoscopy-assisted distal gastrectomy with systemic lymphadenectomy for early gastric cancer.

AIM: To evaluate the nature of the "learning curve" for laparoscopy-assisted distal gastrectomy (LADG) with systemic lymphadenectomy for early gastric cancer. METHODS: The data of 90 consecutive patients with early gastric cancer who underwent LADG with systemic lymphadenectomy between April 2003 and November 2004 were reviewed. The 90 patients were divided into 9 sequential groups of 10 cases in each group and the average operative time of these 9 groups were determined. Other learning indicators, such as transfusion requirements, conversion rates to open surgery, postoperative complication, time to first flatus, and postoperative hospital stay, were evaluated. RESULTS: After the first 10 LADGs, the operative time reached its first plateau (230-240 min/operation) and then reached a second plateau (<200 min/operation) for the final 30 cases. Although a significant improvement in the operative time was noted after the first 50 cases, there were no significant differences in transfusion requirements, conversion rates to open surgery, postoperative complications, time to first flatus, or postoperative hospital stay between the groups. CONCLUSION: Based on operative time analysis, this study show that experience of 50 cases of LADG with systemic lymphadenectomy for early gastric cancer is required to achieve optimum proficiency.

Role of percutaneous transhepatic biliary drainage in patients with complications after gastrectomy.

OBJECTIVE: The aim of this study was to elucidate the role of PTBD in patients with DSL and ALS post-gastrectomy for malignancy or benign ulcer perforation. SUMMARY OF BACKGROUND DATA: Percutaneous transhepatic biliary drainage (PTBD) is an interventional radiologic procedure used to promote bile drainage. Duodenal stump leakage (DSL) and afferent loop syndrome (ALS) can be serious complications after gastrectomy. METHODS: From January 2002 through December 2014, we retrospectively reviewed 19 patients who underwent PTBD secondary to DSL and ALS post-gastrectomy. In this study, a PTBD tube was placed in the proximal duodenum near the stump or distal duodenum in order to decompress and drain bile and pancreatic fluids. RESULTS: Nine patients with DSL and 10 patients with ALS underwent PTBD. The mean hospital stay was 34.3 days (range, 12-71) in DSL group and 16.4 days (range, 6-48) in ALS group after PTBD. A liquid or soft diet was started within 2.6 days (range, 1-7) in the ALS group and within 3.4 days (range, 0-15) in the DSL group after PTBD. One patient with DSL had PTBD changed, and 2 patients with ALS underwent additional surgical interventions after PTBD. CONCLUSIONS: The PTBD procedure, during which the tube was inserted into the duodenum, was well-suited for decompression of the duodenum as well as for drainage of bile and pancreatic fluids. This procedure can be an alternative treatment for cases of DSL and ALS post-gastrectomy.