Postoperative complications for complicated malignant tumours of the stomach

Abstract

Objective —  to determine the frequency and structure of postoperative complications for malignant tumours of the stomach accompanied by gastrointestinal bleeding.

Materials and methods. The study analysed the treatment outcomes of 101 patients with a malignant tumour of the stomach complicated by bleeding (84 cases), perforation (6 cases), or stenosis (19 cases, with 8 of them having both stenosis and bleeding). These patients underwent inpatient treatment at the Kyiv City Centre for Gastrointestinal Bleeding and the Kyiv City Clinical Hospital of Emergency Medical Help between 2015 and 2020. Out of the patients, 78 (77.2%) had histologically confirmed cancer, 11 (10.9%) had GIST, and 12 (11.9%) had malignant lymphoma.

Results. During the peak period of ongoing and recurrent bleeding, 5 (6%) patients required emergency surgery, including 2 (40%) radical and 3 (60%) non‑radical procedures. After proper preoperative preparation and a comprehensive follow‑up assessment, 58 (57.4%) patients underwent radical surgical interventions for stomach cancer complicated by acute gastrointestinal bleeding in the early delayed period. In the early postoperative period, 4 (15.4%) patients experienced complications after 26 radical gastrectomies combined with jejunogastroplasty. In the delayed period, early postoperative complications occurred in 9 (28.1%) patients after 32 radical gastric resections. The total postoperative mortality after emergency surgical interventions was 20.0%. The total postoperative mortality in the early‑term period was 5.7% (5 patients out of 88), which is 3.5% less compared to emergency operations (the difference is statistically significant, p ≤0.05).

Conclusions. When urgent surgical interventions are carried out at the peak of ongoing and recurrent bleeding, the mortality rate from postoperative complications is 3.5 times higher than when operations are performed in the early delayed period after adequate preparation and comprehensive patient monitoring. The death rate after radical operations is 2.1 times lower than that after palliative and symptomatic operations. As the operations conducted during the peak bleeding period are associated with high postoperative mortality, we believe that they pose a high risk to patients with malignant tumours of the stomach.