[Morbidity and Mortality after Subtotal versus Total Open Gastrectomy for Gastric Cancer with Curative Intent: Findings in a Historical Cohort from a Cancer Center].

Abstract

Introduction: Data on morbidity and mortality after subtotal or total gastrectomy are scarce in developing countries, especially considering the epidemiological shift in gastric cancer (decrease in distal and increase in proximal tumors).

Objective: To identify factors associated with morbidity and mortality in patients with gastric cancer undergoing curative-intent surgery at a cancer center in Ecuador.

Materials and methods: Historical cohort study conducted at the National Oncology Institute "Dr. Juan Tanca Marengo" in Guayaquil (2019 - 2021). Only adenocarcinomas treated with curative intent were included. Outcomes were postoperative complications and mortality at 30, 90 days, and overall. Logistic regression was used to estimate factors associated with higher risk.

Results: A total of 111 patients were included (87 subtotal, 24 total gastrectomy). At least one complication occurred in 15.4% (subtotal) and 17.9% (total). Thirty-day, 90-day, and overall mortality after subtotal gastrectomy were 1.1%, 2.3%, and 34.5%; after total gastrectomy, 0%, 4.2%, and 54.2%, respectively. Postoperative complications were significantly associated with Bormann III/IV tumors (OR 9.6; 95% CI 1.8 - 79.7; p = 0.0175) and longer hospital stay (OR 2.3; 95% CI 1.4 - 5.1; p <0.001). Mortality was associated with Bormann III/IV tumors (p = 0.0038) and gastro-duodenal leak (p = 0.0383).

Conclusion: Ninety-day morbidity and mortality rates were lower than previously reported. Bormann III/IV tumors and postoperative gastro-duodenal leakage were associated with increased mortality.