Management of postoperative complications of lymphadenectomy

Abstract

Gastric cancer remains a disease with poor prognosis, mainly due to its late diagnosis. Surgery remains as the only treatment with curative intent, where the goal is radical resection with free-margin gastrectomy and extended lymphadenectomy. Over the last two decades there has been an improvement on postoperative outcomes. However, complications rate is still not negligible even in high volume specialized centers and are directly related mainly to the type of gastric resection: total or subtotal, combined with adjacent organs resection and the extension of lymphadenectomy (D1, D2 and D3). The aim of this study is to analyze the complications specific-related to lymphadenectomy in gastric cancer surgery.

Factors associated with complication after gastrectomy for gastric or esophagogastric cancer compared among surgical purpose, surgical extent, and patient age: Retrospective study from a high volume center in Thailand

“…Percutaneous access was first attempted to evacuate intraabdominal collection, but bilious fluid was found, so surgical exploration was successfully performed to repair the perforation and decontaminate the abdominal cavity. Chyle leakage, which commonly occurs after lymphadenectomy [ 21 ], was found in curative gastrectomy cases only. Diagnosis was made after milky fluid was observed in the abdominal drain, and the triglyceride level in the fluid was over 130 mg/dl.…”

Does epidural analgesia modify the risk of complications after gastrectomy?

“…Complications associated with gastrectomy with D2 lymphadenectomy for the treatment of gastric cancer presents multiple clinical considerations against extensive lymphadenectomy [10,13,14]. The overall rate of complications is between 17 to 48%.…”

“…The overall rate of complications is between 17 to 48%. The most frequent postoperative complications in gastric resection surgeries for curative gastric [9][10][11][12][13][14]18]. Despite the potential for postoperative complications, extensive surgical resection with lymph nodes dissection remains the only curative therapy for gastric cancer worldwide.…”

“…Despite the potential for postoperative complications, extensive surgical resection with lymph nodes dissection remains the only curative therapy for gastric cancer worldwide. Experienced medical institutions specializing in surgical oncology routinely perform extensive curative resections for gastric cancer [9,10,14,19]. Effective analgesia is an essential part of postsurgical management and provides statistically and clinically significant improvements in treatment outcomes.…”

“…The estimated number of complications varies between 17 and 48%. Additionally, gastric resection in conjunction with splenectomy or spleno-pancreatectomy significantly increases the potential for complications [9][10][11][12][13][14]. The management of quality care in postsurgical settings that include administration of regional analgesia contributes to better treatment outcomes [15,16].…”