Abstract
To clarify the therapeutic strategies for gastric cancer surgery in the presence of cirrhosis, 39 patients with gastric cancer accompanied by liver cirrhosis were reviewed. Severe postoperative complications developed in 10 patients (25.6%), and there were 4 (10.3%) hospital deaths, 1 (2.6%) of which occurred within 1 month. Although extended lymph node dissection of D2 or more was adopted for low-risk patients, 3 of 19 patients who underwent such extensive operations, most of which involved complete lymph node dissection in the hepatoduodenal ligament, died. Conversely, only 1 of 20 patients who underwent limited lymph node dissection of D1 or less died. Postoperative massive ascites developed in 6 patients, 3 of whom died. The cumulative 5-year survival rate following curative resection was 63.7% for patients with early gastric cancer, and 13.9% for those with advanced gastric cancer. The most frequent cause of death was cirrhosisrelated, such as hepatic failure or hepatoma. In conclusion, extensive lymph node dissection for patients with gastric cancer accompanied by cirrhosis carried a risk of postoperative fatal massive ascites as lymphorrhea. Thus, lymph node dissection in the hepatoduodenal ligament should be avoided, except in patients with evident metastases, and as a rule, aggressive surgery should not be performed in cirrhotic patients.
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Okajima K, Isozaki H (1993) Principles of surgical treatment. In: Nishi M, Ichikawa H, Nakajima T, Maruyama K, Tahara E (eds) Gastric cancer. Springer, Berlin Heidelberg New York Hong Kong, pp 280–292
Carrison RN, Cryer HM, Howard DA, Polk HC (1984) Clarification of risk factors for abdominal operations in patients with hepatic cirrhosis. Ann Surg 199:648–655
Fekete F, Belghiti J, Cherqui D, Langonnet F, Gayet B (1987) Results of esophagogastrectomy for carcinoma in cirrhotic patients. A series of 23 consecutive patients. Ann Surg 206:74–78
Schwarz SI (1981) Biliary tract surgery and cirrhosis: A critical combination. Surgery 90:577–583
Aranha GV, Sontag SJ, Greenlee HB (1982) Cholecystectomy in cirrhotic patients: A formidable operation. Am J Surg 143:55–60
Isozaki H, Okajima K, Morita S, Ishibashi T, Tanimura M, Hara H, Takeda Y (1993) Surgery for cholelithiasis in cirrhotic patients. Surg Today 23:504–508
Isozaki H, Okajima K, Kawashima Y, Yamada S, Morita S, Nakajima T, Nakata E, Iga C, Ishibashi T (1991) Optimum extent of lymph node dissection in the surgical treatment of gastric cancer accompanied by liver cirrhosis (in Japanese with English abstract). Nippon Shokakigeka Gakkai Zassi (Jpn J Gastroenterol Surg) 24:798–804
Japanese Research Society for Gastric Cancer (1995) Part I. Clinical, surgical, and conclusive findings. Part II. Histologic findings. In: Nishi M, Omori Y, Miwa K (eds) Japanese classification of gastric carcinoma, 1st English ed. Kanehara, Tokyo, pp 1–71
Child CG, Turcotte JF (1964) Surgery and portal hypertension. In: Dunphy JE (ed) The liver and portal hypertension. Saunders, Philadelphia, pp 50–52
Takeda J, Hashimoto K, Tanaka T, Koufuji K, Kakegawa T (1992) Review of operative indications and prognosis in gastric cancer with hepatic cirrhosis. Hepatogastroenterology 39:433–436
Bloch RS, Allaben RD, Walt AJ (1985) Cholecystectomy in patients with cirrhosis. Arch Surg 120:669–672
Sirinek KR, Burk RR, Brown M, Levine BA (1987) Improving survival in patients with cirrhosis undergoing major abdominal operations. Arch Surg 122:271–273
Dumont AE, Mulholland JH (1962) Alternation in thoracic duct lymph flow in hepatic cirrhosis. Significance in portal hypertension. Ann Surg 156:668–677
Isozaki H, Okajima K, Yamada S, Nakata E, Takeda Y, Nishimura J, Ichinona T (1992) Effectiveness of lymph node dissection for advanced gastric cancer. A study of metastasic rate of lymph node and survival rate in patients with lymph node metastasis. Bull Osaka Med Coll 38:83–88
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Isozaki, H., Okajima, K., Ichinona, T. et al. Surgery for gastric cancer in patients with cirrhosis. Surg Today 27, 17–21 (1997). https://doi.org/10.1007/BF01366934
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DOI: https://doi.org/10.1007/BF01366934