TY - JOUR T1 - Lokal İleri Evre Mide Kanserinde Cerrahi Sonuçlar ve Erken Postoperatif Komplikasyonlar TT - Surgical Outcomes and Early Postoperative Complications in Locally Advanced Gastric Cancer AU - Doğan, Lütfi AU - Karaman, Niyazi AU - Hüseyinova, Sevinç AU - Özaslan, Cihangir PY - 2011 DA - August DO - 10.5505/aot.2011.29392 JF - Acta Oncologica Turcica PB - ANKARA HEMATOLOJİ VE ONKOLOJİ DERNEĞİ WT - DergiPark SN - 0304-596X SP - 2 EP - 3 VL - 44 IS - 2 LA - tr AB - AMAÇ: Batı ülkelerinde saptanan mide kanserlerinin %60-65'i tanı anında lokal ileri evrededirler. Bu hastalara uygulanan genişletilmiş rezeksiyonlar komplikasyon riskini arttırabilir. Bu çalışmanın amacı lokal ileri evre mide kanserlerinde rezektabilite, erken dönem mortalite ve morbidite oranlarını saptamaktır. YÖNTEMLER: Ocak 2002 ile Eylül 2006 tarihleri arasında rezeksiyon uygulanan non-metastatik, lokal ileri evre mide kanserli hastalarımız geriye dönük olarak incelendi. BULGULAR: Komşu organ invazyonu nedeni ile 110 hastaya (%49.8) ek organ rezeksiyonu uygulanmıştı. Yüzseksen bir hastaya (%82) R0, 29 hastaya (%13) R1 ve 11 hastaya (%5) R2 rezeksiyon yapılabilmişti. Tüm serinin morbidite ve mortalite oranları sırasıyla %21.7 ve % 4.5 olarak bulundu. İkiden fazla ek organ rezeksiyonu (p=0.001), 2 üniteden fazla kan transfüzyonu (p=0.001) ve düşük protein seviyeleri (p=0.008) multivaryant analizlerde komplikasyon oranlarını arttıran parametreler olarak saptandı. İki veya daha fazla ek organ rezeksiyonu (p=0.001), kardiyovasküler ve respiratuar komorbidite (p=0.002) ve total gastrektomi uygulanması (p=0.028) mortaliteyi arttıran faktörler olarak bulundu. SONUÇ: Neo-adjuvan tedavi uygulanmayan lokal ileri evre mide kanserli hastalarda ek organ rezeksiyonu oranları yüksektir ve bu durum morbidite ve mortalite oranlarını arttırır. Total gastrektomi mortaliteyi arttıran bir faktör olarak belirlenmiş ancak D2 diseksiyonun bu hastalarda güvenle uygulanabileceği sonucuna varılmıştır. KW - komplikasyon KW - lokal ileri evre mide kanseri KW - mortalite KW - morbidite N2 - OBJECTIVE: In Western world, 60 to 65% of the gastric cancer cases are in locally advanced stage at the time of diagnosis and in these patients, extended resections may increase the risk of complications. The aim of this study was to investigate the resectability rates and to determine early morbidity and mortality rates after resections for locally advanced gastric cancer.METHODS: Consecutive non-metastatic locally advanced gastric cancer patients treated between October 2002 and September 2006 were included in this retrospective exploratory analyses study.RESULTS: One hundred and ten patients (49.8%) had additional organ resection due to adjacent organ involvement. R0 resection was achieved in 181 patients (82%), R1 resection in 29 patients (13%), and R2 resection in 11 patients (5%). The morbidity and mortality rates of the all series were 21,7% and 4.5% respectively. More than two additional organ resections (p=0.001), eryhtrocyte transfusions of more than 2 units (p=0.001) and low total protein levels (p=0.008) were determined as the parameters which increase complication rates according to multivariate analysis. The parameters which increase mortality rates were as follows; having two or more additional organ resections (p=0.001), cardiovascular and respiratory comorbidities (p=0.002) and total gastrectomy (p=0.028).CONCLUSION: Additional organ resection rates of the patient with locally advanced gastric cancers that not given neo-adjuvant treatment is high and this occurance increases the morbidity and mortality rates. Altough total gastrectomy has been found to be a factor for increased mortality in locally advanced gastric cancer, D2 dissection is safe for these patients CR - the most common procedures in this group. CR - Two or more additional organ resections were CR - determined as a factor that increases mortality, CR - morbidity and anastomotic dehiscence in CR - multivariate analysis. In a study by Ozer et al., CR - more than two additional organ resections are CR - also related to morbidity (13). CR - Splenectomy was added to the primary CR - procedures of 87 patients. Only 9 of the CR - splenectomies were performed for iatrogenic CR - injuries. The other reasons for splenectomies were CR - implantations on splenic capsule and lymph CR - node involvement in splenic hilus. tumoral CR - In the last few years, the results of CR - different neo-adjuvant chemotherapy regimes CR - given to the patients with radiologically proven CR - invasion to the adjacent structures have been CR - published in the literature. In a series by Wang CR - et al., 87 patients with T4 tumor treated with CR - neoadjuvant chemotherapy and operated with CR - 7% R0 resection rate without any need for CR - adjacent organ resection (24). In a series of 49 CR - patients by Ott et al., this rate was 76% (25). CR - Seventeen of 18 patients presented by Newman CR - (26)and 19 of 22 patients presented by Guo CR - (27) could have been operated with R0 CR - resection without requiring adjacent organ CR - resection. In none of these studies, neoadjuvant chemotherapy CR - operative morbidity and mortality. In our series CR - of locally advanced tumors, not treated with CR - neo-adjuvant chemotherapy, additional organ CR - resection had to be applied in 50% of the cases. CR - At the same time our R1 and R2 resection rates CR - are also high (13% and 5%). In literature, there CR - are some other studies stating that R0 resection CR - rates of locally advanced gastric tumors, not CR - treated with neo-adjuvant chemotherapy, are CR - low (28). But now, there is increasing evidence CR - that neo-adjuvant chemotherapy potentially CR - down-stages the tumor and therefore may CR - improve the resectability rate with negative CR - surgical margins (29,30). to increase CR - In literature, the morbidity and CR - mortality rates for locally advanced gastric CR - cancer surgery changes between 25-30% and CR - 10% respectively (31,32). The mortality rate CR - for earlier stages of gastric cancer is 2-3% CR - (13). Similarly, neo-adjuvant treatment may CR - decrease morbidity and mortality rates by CR - decreasing the need for additional organ CR - resection (16). Patient characteristics can effect mortality and morbidity rates besides the surgical procedures. Advanced age, male sex, blood loss during operation, low total protein and hemoglobin levels and duration of operation were determined as a factors which effect the morbidity rates negatively (33-36). CR - Age, hemoglobin and lymphocyte counts were CR - not found as significant factors for the CR - morbidity in our series. In multivariate CR - analysis, low total protein levels and blood CR - transfusions of more than 2 units were CR - significant factors for the morbidity, whereas CR - cardiac and respiratory comorbidities were CR - significant for the mortality. Low total protein levels CR - necessity lead to immunosuppression and CR - problems in wound healing. Blood transfusions CR - increase intracellular adhesion molecules and CR - this may be the reason for high predisposition CR - to infective complications. In patients with CR - locally advanced gastric cancers, the need for CR - blood transfusion either preoperatively or CR - postoperatively was also high. Cardiac and CR - respiratory problems are the most important CR - causes of early mortality in upper abdominal surgery. blood transfusion Conclusion CR - Additional organ resection rates of the patient CR - with locally advanced gastric cancers that not CR - given neo-adjuvant treatment is high and this CR - occurrence increases the morbidity and CR - mortality rates. While total gastrectomy was CR - preferred surgical option for locally advanced CR - gastric cancers, D2 dissection was used less CR - frequently in this series of patients. 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