Research Article| Volume 220, ISSUE 2, P376-380, August 2020

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Predictive preoperative and intraoperative factors of anastomotic leak in gastrectomy patients

Published:December 31, 2019DOI:


      • 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.



      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.


      Patients who underwent surgery with curative intent for gastric malignancies between 2002 and 2018 were evaluated from a single prospective database.


      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).


      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.


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