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Postoperative Mortality Rates following Total Gastrectomy for Gastric Cancer: Experience of a Single Surgical Team

Objective: Total gastrectomy is a complex surgical procedure that is characterized by significant postoperative morbidity and mortality rates and the patients may continue to experience adverse events beyond the standard 30-day follow-up period after surgery. The aim of this study is to investigate postoperative complication and 30-day/90-day mortality rates following total gastrectomy in a cohort of patients and highlight the possible ways that can improve the short-term outcome of this surgical procedure. 
Material and Methods: 401 patients underwent total gastrectomy for gastric carcinoma by a single surgical team from January 2001 till December 2021. The patients stratified in 3 groups based on the time period when surgery was performed, hospital- and treatment-related objective factors: group I (61 patients); group II (163 patients) and group III (177 patients). 
Results: Esophagojejunal anastomotic leakage rate varied with periods and ranged from 1.1% to 3.3%, 1.7% in total. Differences were insignificant in complication and death rates between the patients aged ≤70 years and > 70 years (p>0.05). Postoperative death rate within 90 days was higher by 42% compared to that in standard 30-day follow-up period. Neaodjuvant chemotherapy was not found to be associated with an increased rate of 30-day postoperative mortality (p>0.05). 
Conclusion(s): Total gastrectomy for gastric cancer may be associated with minimal rates of esophagojejunal anastomotic leakage and mortality when performed by specialized and experienced high-volume surgeons. 90-day mortality rate after total gastrectomy is 42% higher compared to 30-day mortality that warrants more intense monitoring of the relevant patients within 3 months after surgery.