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MORBIDITY AND MORTALITY AFTER TOTAL GASTRECTOMY: A COMPREHENSIVE ANALYSIS OF 90-DAY OUTCOMES
Selena S. Li^*, John T. Mullen
Surgery, Massachusetts General Hospital, Boston, MA
Background: In an effort to improve the informed consent process and to establish benchmarks for future quality improvement initiatives, we sought to comprehensively analyze our 90-day outcomes after total gastrectomy for gastric cancer.
Methods: Detailed 90-day postoperative outcomes on 148 patients who underwent curative-intent total gastrectomy from 2000-2017 were reviewed. Patients who did not have at least 90 days of follow-up were excluded.
Results: The majority (86%) of patients underwent total gastrectomy for a sporadic gastric cancer, whereas 20 (14%) patients had a prophylactic total gastrectomy for hereditary diffuse gastric cancer syndrome. The median age of the cohort was 66 years, and 61% were male. Common comorbidities included hypertension (45%), diabetes mellitus (18%), and coronary artery disease (17%). Thirty-two percent of patients received neoadjuvant chemotherapy. The operative approach was open in 93% of patients and laparoscopic in 7% of patients, and the esophagojejunostomy anastomosis was hand-sewn in 66% and stapled in 34% of patients. An extended (D1+ or D2) lymph node dissection was performed in 37% of patients, while a concomitant distal pancreatectomy and/or splenectomy were performed in 4.7% and 19% of patients, respectively. The 30- and 90-day mortality rates were 2.0% and 3.4%, respectively. One of the 90-day deaths was due to progressive metastatic disease as opposed to surgical complications. Sixty-three (43%) patients experienced at least one 90-day postoperative complication, and 24 (16%) patients experienced a Clavien-Dindo grade 3 or higher complication. The most common complications were pulmonary (16%), cardiac arrhythmias (15%), and anemia (13%). Eight (5.4%) patients had an anastomotic leak, 4 of which required an invasive intervention, and 7 of the patients had a full recovery and one died. Given the small number of events, no statistically significant predictors of anastomotic leak or death could be identified. One (0.7%) patient each had a duodenal stump leak and a pancreatic leak. Median length of stay was 8 days overall but was 22 days in patients with an anastomotic leak. The 30- and 90- day readmission rates were 23% and 31%, respectively.
Conclusions: This study comprehensively defines the 30- and 90-day postoperative outcomes after total gastrectomy that one can expect from a high-volume center. These outcomes data are critical to the improvement of the informed consent process and as benchmarks for future quality improvement initiatives.

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