W Song1, Y Yuan1, J Peng1, J Chen1, F Han1, S Cai1, W Zhan1, Y He2. 1. Department of Gastrointestinal and Pancreatic Surgery, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, PR China. 2. Department of Gastrointestinal and Pancreatic Surgery, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, PR China. Electronic address: YulongH.SYSU@gmail.com.
Abstract
AIMS: This study was designed to investigate the clinical features of delayed massive hemorrhage (DMH) after gastrectomy in patients with gastric cancer (GC). METHODS: This study retrospectively reviewed 1536 GC patients with major gastrectomy between 1998 and 2011. Based on the time onset of postoperative bleeding, patients were divided into early postoperative hemorrhage (EPH), delayed massive hemorrhage (DMH), and no-bleeding groups. Postoperative mortality, bleeding treatment, and risk factors of hemorrhage were explored. RESULTS: In sum, 15 (0.9%) patients suffered from DMH, with three (20%) dead cases. None of 18 (1.2%) patients with EPH died, but there were three dead cases in no-bleeding group. DMH had more extra-intestinal bleeding (P = 0.037) than EPH. Angiographic embolization was performed in 12 (80%) of DMH patients and successful in ten cases. Surgical procedures were applied in only two embolization-failed cases. Extended lymphadenectomy (P = 0.038), vascular skeletonization (P = 0.012) and advanced TNM stage (P < 0.001) were correlated with DMH. CONCLUSIONS: DMH can be successfully managed with angiographic embolization, followed by alternative surgery. Extensive lymphadenectomy and vascular skeletonization should be discreetly performed during gastrectomy.
AIMS: This study was designed to investigate the clinical features of delayed massive hemorrhage (DMH) after gastrectomy in patients with gastric cancer (GC). METHODS: This study retrospectively reviewed 1536 GC patients with major gastrectomy between 1998 and 2011. Based on the time onset of postoperative bleeding, patients were divided into early postoperative hemorrhage (EPH), delayed massive hemorrhage (DMH), and no-bleeding groups. Postoperative mortality, bleeding treatment, and risk factors of hemorrhage were explored. RESULTS: In sum, 15 (0.9%) patients suffered from DMH, with three (20%) dead cases. None of 18 (1.2%) patients with EPH died, but there were three dead cases in no-bleeding group. DMH had more extra-intestinal bleeding (P = 0.037) than EPH. Angiographic embolization was performed in 12 (80%) of DMHpatients and successful in ten cases. Surgical procedures were applied in only two embolization-failed cases. Extended lymphadenectomy (P = 0.038), vascular skeletonization (P = 0.012) and advanced TNM stage (P < 0.001) were correlated with DMH. CONCLUSIONS:DMH can be successfully managed with angiographic embolization, followed by alternative surgery. Extensive lymphadenectomy and vascular skeletonization should be discreetly performed during gastrectomy.
Authors: Kichang Han; Bestun Mustafa Ahmed; Man-Deuk Kim; Jong Yun Won; Do Yun Lee; Gyoung Min Kim; Joon Ho Kwon; Sung Il Park; Sung Hoon Noh; Woo Jin Hyung Journal: Gastric Cancer Date: 2017-02-13 Impact factor: 7.370