Abstract
BackgroundMassive abdominal arterial bleeding is an uncommon yet life-threatening complication of radical gastrectomy. The exact incidence and standardized management of this lethal morbidity are not known. MethodsBetween January 2003 and December 2013, data from 1875 patients undergoing radical gastrectomy with D2 or D2 plus lymphadenectomy were recorded in a prospectively designed database from a single institute. The clinical data and management of both early (within 24 h) and late (beyond 24 h) postoperative abdominal arterial hemorrhages were explored. For late bleeding patients, transcatheter arterial embolization (TAE) and re-laparotomy were compared to determine the better initial treatment option. ResultsThe overall prevalence of postoperative abdominal arterial bleeding was 1.92 % (n = 36), and related mortality was 33.3 % (n = 12). Early and late postoperative bleedings were found in 6 and 30 patients, respectively. The onset of massive arterial bleeding occurred on average postoperative day 19. The common hepatic artery and its branches were the most common bleeding source (13/36; 36.1 %). All the early bleeding patients were treated with immediate re-laparotomy. For late bleeding, patients from the TAE group had a significantly lower mortality rate than that of the patients from the surgery group (7.69 vs. 56.25 %, respectively, P = 0.008) as well as a shorter procedure time for bleeding control (2.3±1.1 vs. 4.8±1.7 h, respectively, P < 0.001). Four rescue reoperations were performed for TAE failures; the salvage rate was 50 % (2/4). Ten patients developed massive re-bleeding after initial successful hemostasis by either TAE (5/13) or open surgery (5/16). Three out of the 10 re-bleeding patients died of disseminated intravascular coagulation (DIC), while the other 7 recovered eventually by repeated TAE and/or surgery. ConclusionAbdominal arterial bleeding following radical gastrectomy tends to occur during the later phase after surgery, with further complications such as abdominal infection and fistula(s). For late bleeding, TAE can be considered as the first-line treatment when possible.
Highlights
Mortality and morbidity of gastric cancer surgery have decreased in recent decades, especially in high-volume centers,[1,2,3] postoperative massive hemorrhage is still a devastating complication with a high mortality rate that ranges fromJ Gastrointest Surg (2016) 20:510–5202.6 to 26.6 %.4–8 Among frequent causes, abdominal arterial bleeding, mainly from the branches of the celiac trunk or the common hepatic artery, is a specific postoperative morbid event after D2 or D2 plus lymphadenectomy
All the early bleeding patients were treated with immediate re-laparotomy
Gastrectomy tends to occur during the later phase after surgery, with further complications such as abdominal infection and Electronic supplementary material The online version of this article fistula(s)
Summary
Mortality and morbidity of gastric cancer surgery have decreased in recent decades, especially in high-volume centers,[1,2,3] postoperative massive hemorrhage is still a devastating complication with a high mortality rate that ranges fromJ Gastrointest Surg (2016) 20:510–5202.6 to 26.6 %.4–8 Among frequent causes, abdominal arterial bleeding, mainly from the branches of the celiac trunk or the common hepatic artery, is a specific postoperative morbid event after D2 or D2 plus lymphadenectomy. Mortality and morbidity of gastric cancer surgery have decreased in recent decades, especially in high-volume centers,[1,2,3] postoperative massive hemorrhage is still a devastating complication with a high mortality rate that ranges from. Gastrectomy with D2 or D2 plus lymph node dissection has been the long-standing standard procedure for locally advanced gastric cancer in most hospitals in Eastern Asia. The morbidity and mortality of emergency re-laparotomy are high in late postoperative period.[3,9] With the advances in radiology techniques, angiography and transcatheter arterial embolization (TAE), as an alternative to re-operation, have been widely used for the diagnosis and treatment of postoperative arterial bleeding from pancreatic or other abdominal surgeries.[10,11,12,13]. Massive abdominal arterial bleeding is an uncommon yet life-threatening complication of radical gastrectomy. The exact incidence and standardized management of this lethal morbidity are not known
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