Rationale of reoperation for gastric malignancies
Mäkelä, J.; Kairaluoma, M.I.
Annales Chirurgiae et Gynaecologiae 74(2): 77-81
1985
ISSN/ISBN: 0355-9521 PMID: 2411184 Document Number: 264104
The aim of this retrospective study was to elucidate the role and rationale of reoperation for tumour recurrence in 47 consecutive patients operated on for gastric cancer. The overall operative mortality was 26%, morbidity 45%, mean and median survivals 14 .+-. 25 and 5 months, respectively, postoperative symptomfree period 8 .+-. 23 months, and cumulative 5-year survival 8 .+-. 3%. Bypass procedures and resection carried the lowest mortality, 7% and 20%, respectively, whereas the corresponding percentages after colostomy, exploratory laparotomy and jejunostomy were 33%, 40% and 50%. Resection yielded a significantly longer mean (41 .+-. 44 mos) and median (82 mos) survival than other procedures. The postoperative symptom free period after resection (34 .+-. 42 mos) was significantly longer than after exploratory laparotomy and bypass procedures, whereas the difference between resection and enterostomy was insignificant. After exploratory laparotomy, colo- and jejunostomy the median survivals were under 2 months. We conclude that only resection, when possible, favorably affects survival and we emphasize the importance of regular endoscopic follow-up after operation for gastric cancer. Resection and bypass procedures are most suitable for long-lasting palliation at reoperation for gastric malignancy. Unnecessary laparotomies, if the diagnosis can be confirmed by other means, and useless jejunostomies should be avoided in patients with far-advanced metastatic disease and short life expectancy.