BACKGROUND/AIMS:There was obvious disparity in postoperative mortality rate of gastric cancer surgery among different centers. We analyzed the postoperative complications of gastric cancer surgery at a pioneer surgical center in China and discussed the possible reason behind lower postoperative mortality rate at this center.METHODOLOGY:A total of 697 patients of gastric cancer surgery were analyzed. The median age of the patients was 58 years. POSSUM (Physiological and operative severity score for the enumeration of morbidity and mortality) was applied to calculate risk adjusted morbidity rate.RESULTS:About 82 percent patients were discharged uneventfully in less than 15 days after surgery. Overall 159 patients had postoperative complications, majority of complication were mild or moderate, only about 4 percent of patients had severe complications. Postoperative anastomotic leak and mortality rate was 1.3 and 0.3 percent respectively.CONCLUSION:The postoperative complications especially the mortality rate was significantly lower in our center. The clinical and surgical experience may have influenced the surgical outcome; however, a well controlled prospective study is necessary to postulate this assumption. Regardless of the reason behind the disparity in postoperative mortality rate among different centers, it is mandatory to minimize the postoperative mortality rate of oncological disease like gastric cancer.

The prognosis for patients with stage IV gastric cancer is still very poor. The purpose of this study was to evaluate the surgical outcome and prognosis, and to determine the prognostic influence of sub‐stages of stage IV gastric cancer.

Purpose We investigated the risk factors for early postoperative complications after gastric cancer surgery. Materials and methods The data from a total of 273 patients with gastric cancer were analyzed by univariate and multivariate analysis. We applied physiological and operative severity score for the enumeration of morbidity and mortality (POSSUM) to compare risk-adjusted surgical outcomes among different surgical units. Results Among the preoperative variables, patient gender, chronic obstructive pulmonary disease, surgical unit, and intraoperative blood loss were independent risk factors for a higher rate of postoperative complications. There were significant differences in complication rates among different surgical units ( P = 0.001). The observed-to-expected morbidity ratio (O-to-E ratio) ranged from 0.81 to 1.63. Units with low surgical work volume had higher complication rates. Postoperative length of stay was significantly shorter ( P = 0.000) and the rate of moderate and severe complications was significantly lower ( P = 0.001) in specialized unit. Conclusions POSSUM is a valid system for risk-adjusted evaluation of surgical outcomes. We conclude that surgical experience and work volume greatly influence the outcome, with overall surgical outcome in specialized centers superior to that in other units. Hence, gastric cancer surgery should be performed in specialized centers. Risk factors identified in this study need further confirmation by a prospective study involving a larger cohort.

POSSUM (Physiological and Operative Severity Score for the enUmeration of Morbidity and mortality) has been proposed as a promising system for risk adjusted audit in surgical practice. However it has not been generalized in gastric cancer surgery. Present study evaluates the POSSUM on malignant gastric cases in Chinese hospital where patient population or healthcare system might be different than United Kingdom (UK) where the formula was devised.

AIMS:This study was undertaken to investigate the clinical effects and safety of intraoperative peritoneal hyperthermic chemotherapy (IPHC) for advanced gastric cancer (AGC) patients.METHODS:A total of 118 AGC patients with serosal invasion were enrolled in this study from 1998 to 2001, 52 underwent IPHC after gastrectomy and 66 were treated with gastrectomy only. Among these cases, 96 patients without macroscopic peritoneal metastases were selected for the prophylactic study, 22 with peritoneal metastases were selected for the therapeutic study. Postoperative survival, recurrence pattern and incidences of postoperative complications between patients with and without IPHC were analyzed and compared.RESULTS:For the prophylactic study, the IPHC procedure improves postoperative survival rate and decrease the incidence of peritoneal recurrence, and is an independent prognostic factor for these patients. For the therapeutic study, postoperative survival times were longer if IPHC was undertaken. No surgery-related death occurred. The incidence of renal dysfunction was higher in the IPHC group, but all patients recovered without hemodialysis.CONCLUSION:IPHC is a safe procedure that improves the survival prognosis for AGC patients with serosal invasion. It is especially beneficial for patients without peritoneal metastasis due to the reduction of postoperative peritoneal recurrence.