POSTOPERATIVE COMPLICATIONS AFTER TOTAL GASTRECTOMY IN THE GASTRIC CANCER. ANALYSIS OF 300 PATIENTS Complicações pós-operatórias após gastrectomia total no câncer gástrico. Análise de 300 doentes

HEADINGS Gastric adenocarcinoma. Total gastrectomy. Complications. Digestive fistula. ABSTRACT Background A total gastrectomy is considered a procedure with a high level of complexity, has high complication rates, both local and general, because patients are mostly with clinical conditions and nutritional compromised by disease. Aim To analyse the results and complications of the total gastrectomy in gastric cancer in the period from 1972 to 2007. Methods Were reviewed the medical records of 300 patients with gastric adenocarcinoma, divided into two periods: from 1972 to 1992 comprising 108 patients (36%) and from 1993 to 2007 comprising 192 patients (64%). They were 67.3% males, 70.7% whites, with ages ranging from 25 to 86 years (mean 63.4 years). The lesions were located in cardia 40 cases (13.3%), gastric fundus 83 cases (27.6%), gastric body 77 cases (25.6%); plastic linitis45 cases (15%); gastric stump 33 cases (11%) and antrum and body gastric 22 cases (7.3%). A total gastrectomy with extended lymphadenectomy to level D2 was performed in 246 cases (82%). Results The reconstruction technique used was the esophagus-jejunal anastomosis end-to-side Roux-en-Y in 257 patients (86.7%). The general complications in the period from 1972 to 1992 totalized 47 cases (43.5%), mainly involving the respiratory (28 cases 25.9%) and urinary tract (10 cases 9.2%). In the period from 1993 to 2007 amounted to 48 cases (25%), mainly respiratory complications (27 cases 14%), followed by urinary (12 cases 6.2%). The local complications from 1972 to 1992 totalized 45 cases (30.8%) and in the period from 1993 to 2007 amounted to 28 cases (14.5%), being the most frequent the digestive fistulas. The operative mortality through 30 days was 18 cases (6%), while in the period from 1972 to 92 a total of 12 cases (11.1%) and in the period from 1993 to 2007 were 7 cases (3.6%). Conclusions Total gastrectomy is a procedure that requires a skilled surgeon, his team, using an improved surgical technique to minimize postoperative complications. The postoperative complications requiring care in controlling infections, airway and nutritional care, reducing mortality, increasing survival and contributing to quality of life of patients. ABCDDV/776