[Postoperative morbidity and in-hospital mortality of gastrectomy due to gastric adenocarcinoma: a report of 50 years]. / Morbilidad post operatoria y mortalidad intrahospitalaria de la gastrectomia por adenocarcinoma gastrico: analisis de 50 años.

OBJECTIVE: Determine the postoperative morbidity and in-hospital mortality of gastrectomy due to gastric cancer. METHOD: The study involved the review of the clinical records of all patients with histologically confirmed diagnostic of gastric adenocarcinoma, which underwent a gastrectomy at the Peruvian Institute of Neoplastic Diseases between January 1950 and December 1999. During that period, 2,033 gastrectomies were performed, 503 of which were total gastrectomies and 1,447 were distal subtotal gastrectomies. Postoperative morbidity of total and distal subtotal gastrectomy dropped from 23.7% and 14.3% during the 1950 decade, to 19.8% and 7.4% during the 1990 decade, respectively, while the in-hospital mortality of total and subtotal gastrectomy dropped from 28.9% and 19.4% during the 50s to 4.4% and 2.2% during the 90's. The most common complications were the esophagojejunal, gastrojejunal and duodenal fistulas, respiratory infections, intra-abdominal abscesses, pancreatic fistula, early intestinal obstruction, hemorrhage from the anastomosis site and surgical site infection. RESULTS: Multivariate logistics regression analysis showed that the risk factors for in-hospital mortality of total gastrectomy were hypoalbuminemia, intraoperative blood transfusion and re-resection (OR: 2.4, 5.9 and 1.7, respectively). For distal subtotal gastrectomy, the risk factors for in-hospital mortality were hypoalbuminemia, intraoperative blood transfusion, splenectomy and re-resection (OR: 2.6, 2.46, 2.42 and 6.3, respectively). CONCLUSIONS: Based on our results, the in-hospital mortality risk depends on the postoperative variables (hypoalbuminemia, intraoperative blood transfusion, splenectomy and re-resection) more than on the pre-operative variables, beyond the surgeon's control (age, sex, clinical stage, etc.).

Estudio clínico patológico de 100 autopsias de pacientes con cáncer de Estómago en relación con la historia natural de la enfermedad, tipo histológicos y causa de muerte / A study clinical - patological of one hundres autopsias of patient with cancer of stomach in relation with its natural history, histological types and cause of death

Se estudian autopsias de pacientes con cáncer de estómago, en el Instituto Nacional de Enfermedades Neoplásicas (Lima-Perú) de 1,952 a 1,976. 70 pacientes con evolución natural de la enfermedad, 61 de ellos murieron por carcinomatosis y 9 por complicaciones u otras enfermedades. 30 pacientes gastrectomizados, 11 de ellos murieron por carcinomatosis y 19 no tuvieron metástasis a distancia y la causa de muerte fue por complicaciones post-operatorias. De los 100 casos, 46 corresponden al tipo histológico "Difuso", 44 al tipo "Intestinal" y 10 mixtos. El tipo "Difuso es más frecuente en los pacientes de menor edad, del sexo femenino, macroscopicamente al tipo Borrmann IV y da metástasis más frecuentemente a peritoneo. El tipo "Intestinal" es más frecuente en los de mayor edad, macroscopicamente a los tipos Borrmann I, II y III y da metástasis más frecuente a hígado