Predisposing Factors and Management of Postoperative Bleeding After Radical Gastrectomy for Gastric Carcinoma

Overview

Journal Surg Today

Specialty General Surgery

Date 2011 Mar 3

PMID 21365417

Citations 13

Authors

Oh Jeong

Young Kyu Park

Seong Yeob Ryu

Dong Yi Kim

Ho Kun Kim

Mi Ran Jeong

Affiliations

Soon will be listed here.

Abstract

Purpose: To promote proper management of postoperative bleeding, we investigated the clinical manifestations, predisposing factors, diagnostic approaches, and treatments of bleeding complications after gastric cancer surgery.

Methods: Using a prospectively constructed database, we reviewed retrospectively 39 patients who suffered bleeding complications from among a total 1027 patients who underwent surgery for gastric cancer between 2004 and 2008.

Results: Operating time (hazard ratio [HR] 1.842, 95% confidence interval [CI] 1.524-2.367) and body mass index (HR 1.454, 95% CI 1.128-1.792) were significant predisposing factors for postoperative bleeding after gastric cancer surgery. Luminal bleeding occurred in 16 patients: as simple anastomosis site bleeding, treated successfully with conservative or endoscopic treatment, in 13; and as pseudoaneurysmal bleeding in 3, treated successfully with surgery in 2, but resulting in the death of 1. Abdominal bleeding occurred in 23 patients, requiring surgery in 9 and arterial embolization in 1. The most common finding at reoperation was bleeding from the mesocolon surface. The mean hospital stay of patients with postoperative bleeding was 21 (± 20) days.

Conclusions: Postoperative bleeding can be managed successfully with a tailored approach, considering its origins and clinical manifestations. Arterial pseudoaneurysms are a rare cause of luminal bleeding, but they can be fatal and should be suspected when extensive luminal bleeding presents after gastric cancer surgery.

Citing Articles

Endoscopic Management of Bleeding in Altered Anatomy after Upper Gastrointestinal Surgery.

Gibiino G, Binda C, Secco M, Giuffrida P, Coluccio C, Perini B Medicina (Kaunas). 2023; 59(11).

PMID: 38003990 PMC: 10672978. DOI: 10.3390/medicina59111941.

Endoscopic management of postoperative bleeding.

Ryou S, Bang K Clin Endosc. 2023; 56(6):706-715.

PMID: 37915192 PMC: 10665615. DOI: 10.5946/ce.2023.028.

Ten-Year Multicenter Retrospective Study Utilizing Machine Learning Algorithms to Identify Patients at High Risk of Venous Thromboembolism After Radical Gastrectomy.

Liu Y, Song C, Tian Z, Shen W Int J Gen Med. 2023; 16:1909-1925.

PMID: 37228741 PMC: 10202705. DOI: 10.2147/IJGM.S408770.

Postoperative major bleeding risk in patients using oral antiplatelets and/or anticoagulants after laparoscopic gastric cancer surgery.

Im C, Park Y, Min S, Kang S, Lee S, Lee E Ann Surg Treat Res. 2023; 104(2):80-89.

PMID: 36816732 PMC: 9929431. DOI: 10.4174/astr.2023.104.2.80.

Common hepatic artery pseudoaneurysm: A rare complication following total gastrectomy: A case report.

Kharel S, Shrestha S, Gyawali N, Maharjan N, Thapa A, Kandel B Int J Surg Case Rep. 2021; 81:105816.

PMID: 33887837 PMC: 8027270. DOI: 10.1016/j.ijscr.2021.105816.

References

Hu J, Yang K, Zhang B, Chen X, Chen Z, Chen J . D2 plus para-aortic lymphadenectomy versus standardized D2 lymphadenectomy in gastric cancer surgery. Surg Today. 2009; 39(3):207-13. DOI: 10.1007/s00595-008-3856-x. View

Neuman H, Zarzaur B, Meyer A, Cairns B, Rich P . Superselective catheterization and embolization as first-line therapy for lower gastrointestinal bleeding. Am Surg. 2005; 71(7):539-44. View

Blanc T, Cortes A, Goere D, Sibert A, Pessaux P, Belghiti J . Hemorrhage after pancreaticoduodenectomy: when is surgery still indicated?. Am J Surg. 2007; 194(1):3-9. DOI: 10.1016/j.amjsurg.2006.08.088. View

Lefkovitz Z, Cappell M, Kaplan M, Mitty H, Gerard P . Radiology in the diagnosis and therapy of gastrointestinal bleeding. Gastroenterol Clin North Am. 2000; 29(2):489-512. DOI: 10.1016/s0889-8553(05)70124-2. View

Hagiwara A, Sawai K, Sakakura C, Shirasu M, OHGAKI M, Yamasaki J . Complete omentectomy and extensive lymphadenectomy with gastrectomy improves the survival of gastric cancer patients with metastases in the adjacent peritoneum. Hepatogastroenterology. 1998; 45(23):1922-9. View

Kim D, Joo J, Ryu S, Kim Y, Kim S, Jung Y . Pseudoaneurysm of gastroduodenal artery following radical gastrectomy for gastric carcinoma patients. World J Gastroenterol. 2003; 9(12):2878-9. PMC: 4612078. DOI: 10.3748/wjg.v9.i12.2878. View

Sano T, Sasako M, Yamamoto S, Nashimoto A, Kurita A, Hiratsuka M . Gastric cancer surgery: morbidity and mortality results from a prospective randomized controlled trial comparing D2 and extended para-aortic lymphadenectomy--Japan Clinical Oncology Group study 9501. J Clin Oncol. 2004; 22(14):2767-73. DOI: 10.1200/JCO.2004.10.184. View

Uyama I, Ogiwara H, Takahara T, Kikuchi K, Iida S, Kubota T . Spleen- and pancreas-preserving total gastrectomy with superextended lymphadenectomy including dissection of the para-aortic lymph nodes for gastric cancer. J Surg Oncol. 1996; 63(4):268-70. DOI: 10.1002/(SICI)1096-9098(199612)63:4<268::AID-JSO10>3.0.CO;2-#. View

Degiuli M, Sasako M, Calgaro M, Garino M, Rebecchi F, Mineccia M . Morbidity and mortality after D1 and D2 gastrectomy for cancer: interim analysis of the Italian Gastric Cancer Study Group (IGCSG) randomised surgical trial. Eur J Surg Oncol. 2004; 30(3):303-8. DOI: 10.1016/j.ejso.2003.11.020. View

10.

Ellison E . Evidence-based management of hemorrhage after pancreaticoduodenectomy. Am J Surg. 2007; 194(1):10-2. DOI: 10.1016/j.amjsurg.2006.12.034. View

11.

Yuan Y, Wang C, Hunt R . Endoscopic clipping for acute nonvariceal upper-GI bleeding: a meta-analysis and critical appraisal of randomized controlled trials. Gastrointest Endosc. 2008; 68(2):339-51. DOI: 10.1016/j.gie.2008.03.1122. View

12.

MOULTON M, Creswell L, Mackey M, Cox J, Rosenbloom M . Reexploration for bleeding is a risk factor for adverse outcomes after cardiac operations. J Thorac Cardiovasc Surg. 1996; 111(5):1037-46. DOI: 10.1016/s0022-5223(96)70380-x. View

13.

Japanese Gastric Cancer Association . Japanese Classification of Gastric Carcinoma - 2nd English Edition -. Gastric Cancer. 2002; 1(1):10-24. DOI: 10.1007/s101209800016. View

14.

Kim M, Kim W, Kim H, Ryu S, Ryu S, Song K . Risk factors associated with complication following laparoscopy-assisted gastrectomy for gastric cancer: a large-scale korean multicenter study. Ann Surg Oncol. 2008; 15(10):2692-700. DOI: 10.1245/s10434-008-0075-z. View

15.

Park D, Lee H, Kim H, Yang H, Lee K, Choe K . Predictors of operative morbidity and mortality in gastric cancer surgery. Br J Surg. 2005; 92(9):1099-102. DOI: 10.1002/bjs.4952. View

16.

Piffaretti G, Tozzi M, Carrafiello G, Caronno R, Lagana D, Recaldini C . A case of gastroduodenal artery aneurysm in a HIV-positive patient treated by combined percutaneous thrombin injection and endovascular coil embolization. J Cardiovasc Surg (Torino). 2008; 49(5):659-61. View

17.

Cooper G, Chak A, Way L, Hammar P, Harper D, Rosenthal G . Early endoscopy in upper gastrointestinal hemorrhage: associations with recurrent bleeding, surgery, and length of hospital stay. Gastrointest Endosc. 1999; 49(2):145-52. DOI: 10.1016/s0016-5107(99)70478-5. View