Gastric Cancer
Copyright ©The Author(s) 2005. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastroenterol. Aug 14, 2005; 11(30): 4623-4627
Published online Aug 14, 2005. doi: 10.3748/wjg.v11.i30.4623
Gastric cancer surgery in cirrhotic patients: Result of gastrectomy with D2 lymph node dissection
Jun Ho Lee, Junuk Kim, Jae Ho Cheong, Woo Jin Hyung, Seung Ho Choi, Sung Hoon Noh
Jun Ho Lee, Research Institute and Hospital, National Cancer Center, Goyang, South Korea
Junuk Kim, Jae Ho Cheong, Woo Jin Hyung, Seung Ho Choi, Sung Hoon Noh, Department of Surgery, Yonsei University College of Medicine, Seoul, South Korea
Jae Ho Cheong, Woo Jin Hyung, Sung Hoon Noh, Cancer Metastasis Research Center, Yonsei University College of Medicine, Seoul, South Korea
Woo Jin Hyung, Sung Hoon Noh, Brain Korea 21 Project for the Medical Sciences, Yonsei University College of Medicine, Seoul, South Korea
Correspondence to: Dr. Sung Hoon Noh, Department of Surgery, College of Medicine, Yonsei University, C.P.O. Box 8044, Seoul, South Korea. sunghoonn@yumc.yonsei.ac.kr
Telephone: +82-2-361-5540 Fax: +82-2-313-8289
Received: November 23, 2004
Revised: December 3, 2004
Accepted: December 8, 2004
Published online: August 14, 2005
Abstract

AIM: To explore the feasibility of performing gastrectomy with D2 lymphadenectomy in gastric cancer patients with liver cirrhosis.

METHODS: A total of 7 178 patients were admitted with a diagnosis of liver cirrhosis from January 1993 to December 2003. We reviewed the records of 142 patients who were diagnosed with liver cirrhosis and gastric adenocarcinoma during the same period. Gastrectomy with D2 lymph node dissection for carcinoma of the stomach was performed in 94 patients with histologically proven hepatic cirrhosis.

RESULTS: All but 12 patients were classified as Child’s class A. Only 35 patients (37.2%) were diagnosed with cirrhosis before operation. Seventy-three patients underwent a subtotal gastrectomy (77.7%) and 21 patients (22.3%) underwent a total gastrectomy, each with D2 or more lymph node dissection. Two patients (3.8%) who had prophylactic intra-operative drain placement, died of postoperative complications from hepatorenal failure with intractable ascites. Thirty-seven patients (39.4%) experienced postoperative complications. The extent of gastric resection did not influence the morbidity whereas serum aspartate aminotransferase level (P = 0.011) and transfusion did (P = 0.008). The most common postoperative complication was ascites (13.9%) followed by wound infection (10.6%).

CONCLUSION: We concluded that the presence of compensated cirrhosis, i.e. Child class A, is not a contraindication against gastrectomy with D2 or more lymph node dissection, when curative resection for gastric cancer is possible. Hepatic reserve and meticulous hemostasis are the likely determinants of operative prognosis.

Keywords: Gastric cancer; Liver cirrhosis; D2 lymph node dissection; Morbidity; Mortality