Highlights
- •Gastric cancer resected in 195 patients, 40% had post-operative complications (POC).
- •5-year OS for patients without POCs was 74% v 49% for patients with POCs.
- •Limiting anastomotic stress and using enteral feeding tube may reduce POCs.
Abstract
Background
The preoperative and intraoperative factors that could predict a higher risk of anastomotic/staple
line leak for gastric cancer patients has not been accurately defined.
Methods
Patients who underwent surgery with curative intent for gastric malignancies between
2002 and 2018 were evaluated from a single prospective database.
Results
A total of 195 patients were evaluated with an overall complication rate of 40%. Anastomotic/staple
line leak occurred in 13%, with 4% undergoing reoperation during the same hospitalization.
Significant risk factors affecting postoperative complications (POC) were identified
in the patients including number of comorbidities (≥2) (HR, 5.30; 95% CI, 1.1–15.3;
P = 0.037) and operation type (Total vs Distal) (HR, 2.5; CI 1.08–8.5; p = 0.048).
Subset analysis of gastric adenocarcinoma patients demonstrates a five-year overall
survival (OS) for patients without perioperative complications was 68%, compared with
41% for patients with POCs (p 0.001).
Conclusions
In a large single-institutional study, POCs were associated with decreased survival
in patients undergoing surgery for gastric adenocarcinoma. Optimizing these patients
post-operatively with limited anastomotic stress and enteral feeding tube may allow
for a less complicated course.
Keywords
To read this article in full you will need to make a payment
Purchase one-time access:
Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online accessOne-time access price info
- For academic or personal research use, select 'Academic and Personal'
- For corporate R&D use, select 'Corporate R&D Professionals'
Subscribe:
Subscribe to The American Journal of SurgeryAlready a print subscriber? Claim online access
Already an online subscriber? Sign in
Register: Create an account
Institutional Access: Sign in to ScienceDirect
References
- Poor prognosis in esophageal cancer patients with postoperative complications.Surg Today. 1998; 28 (PubMed PMID: 9681604. Epub 1998/07/29): 576-579
- Poor survival rate in patients with postoperative intra-abdominal infectious complications following curative gastrectomy for gastric cancer.Ann Surg Oncol. 2013 May; 20 (PubMed PMID: 23076557. Epub 2012/10/19): 1575-1583
- A preoperative nomogram to predict the risk of perioperative mortality following gastric resections for malignancy.J Gastrointest Surg. 2012 Nov; 16 (PubMed PMID: 22948837. Epub 2012/09/06): 2026-2036
- Restrictive blood transfusion protocol in malignant upper gastrointestinal and pancreatic resections patients reduces blood transfusions with no increase in patient morbidity.Am J Surg. 2015 Dec; 210 (PubMed PMID: 26602534): 1197-1205
- The impact of enhanced recovery pathways on cost of care and perioperative outcomes in patients undergoing gastroesophageal and hepatopancreatobiliary surgery.Surgery. 2018 Oct; 164 (PubMed PMID: 30072252. Epub 2018/08/04): 719-725
- Minimally invasive feeding tube and esophageal stent placement.Minimally invasive foregut surgery for malignancy: Principles and practice. 2015; 1: 183-188
- Long-term outcomes after hand-sewn versus circular-stapled (25 and 29 mm) anastomotic technique after esophagogastrectomy for esophageal cancer.J Surg Oncol. 2018 Mar; 117 (PubMed PMID: 29044576. Epub 2017/10/19): 469-472
- Classification and treatment of anastomotic leakage after extended total gastrectomy in gastric carcinoma.Hepato-Gastroenterology. 1990 Dec; 37 (PubMed PMID: 2083933. Epub 1990/12/01): 174-177
- Conservative management of anastomotic leaks after 557 open gastric bypasses.Obes Surg. 2005 Oct; 15 (PubMed PMID: 16259881. Epub 2005/11/02): 1252-1256
- Conservative management of anastomotic leaks.Obes Surg. 2006 Mar; 16 (author reply 6. PubMed PMID: 16545173. Epub 2006/03/21): 375-376
- Classification of surgical complications: a new proposal with evaluation in a cohort of 6336 patients and results of a survey.Ann Surg. 2004 Aug; 240 (PubMed PMID: 15273542. Pubmed Central PMCID: PMC1360123. Epub 2004/07/27): 205-213
- A new method of classifying prognostic comorbidity in longitudinal studies: development and validation.J Chronic Dis. 1987; 40 (PubMed PMID: 3558716. Epub 1987/01/01): 373-383
- Esophagojejunal anastomosis leakage after total gastrectomy for esophagogastric junction adenocarcinoma: options of treatment.J Gastrointest Oncol. 2016 Aug; 7 (PubMed PMID: 27563440. Pubmed Central PMCID: PMC4963362. Epub 2016/08/27): 515-522
- Impact of anastomotic leakage on long-term survival after total gastrectomy for carcinoma of the stomach.Br J Surg. 2010 Jul; 97 (PubMed PMID: 20632269. Epub 2010/07/16): 1035-1042
- Impact of postoperative complications on long-term survival after radical resection for gastric cancer.World J Gastroenterol. 2013 Jul 7; 19 (PubMed PMID: 23840153. Pubmed Central PMCID: PMC3703195. Epub 2013/07/11): 4060-4065
- Surgical morbidity and mortality after neoadjuvant chemotherapy in the CRITICS gastric cancer trial.Eur J Surg Oncol. 2018 May; 44 (PubMed PMID: 29503129. Epub 2018/03/06): 613-619
- Standard radical gastrectomy in octogenarians and nonagenarians with gastric cancer: are short-term surgical results and long-term survival substantial?.J Gastrointest Surg. 2012 Apr; 16 (PubMed PMID: 22350724. Epub 2012/02/22): 728-737
- Permanent loss of preoperative independence in elderly patients undergoing hepatectomy: key factor in the informed consent process.J Gastrointest Surg : official journal of the Society for Surgery of the Alimentary Tract. 2016 May; 20 (PubMed PMID: 26811246): 936-944
- Psychosocial risks are independently associated with cancer surgery outcomes in medically comorbid patients.Ann Surg Oncol. 2019 Apr; 26 (PubMed PMID: 30617868. Epub 2019/01/09): 936-944
- Does neoadjuvant chemotherapy cancel out the negative survival impact induced by surgical complications after gastrectomy?.Gastric Cancer. 2019 Apr 3; (PubMed PMID: 30945120. Epub 2019/04/05)
Article info
Publication history
Published online: December 31, 2019
Accepted:
December 30,
2019
Received in revised form:
December 20,
2019
Received:
October 31,
2019
Identification
Copyright
© 2020 Elsevier Inc. All rights reserved.
