Risk factors for esophago-jejunal anastomosis leakage after total gastrectomy for cancer. A multicenter retrospective study of the Italian research group for gastric cancer.
Adolescent
Adult
Aged
Aged, 80 and over
Anastomosis, Surgical
/ methods
Anastomotic Leak
/ epidemiology
Carcinoma
/ surgery
Comorbidity
Conservative Treatment
Endoscopy, Digestive System
Esophagus
/ surgery
Female
Gastrectomy
Humans
Ileus
/ epidemiology
Italy
/ epidemiology
Jejunum
/ surgery
Length of Stay
/ statistics & numerical data
Lymph Node Excision
/ methods
Male
Middle Aged
Minimally Invasive Surgical Procedures
/ statistics & numerical data
Mortality
Postoperative Complications
/ epidemiology
Postoperative Hemorrhage
/ epidemiology
Reoperation
Respiratory Tract Diseases
/ epidemiology
Retrospective Studies
Risk Factors
Stomach Neoplasms
/ surgery
Surgical Wound Dehiscence
/ epidemiology
Survival Rate
Young Adult
Comorbidities
Esophago-jejunal anastomosis leakage
Gastric cancer
Minimally invasive surgery
Total gastrectomy
Journal
European journal of surgical oncology : the journal of the European Society of Surgical Oncology and the British Association of Surgical Oncology
ISSN: 1532-2157
Titre abrégé: Eur J Surg Oncol
Pays: England
ID NLM: 8504356
Informations de publication
Date de publication:
12 2020
12 2020
Historique:
received:
30
04
2020
revised:
25
05
2020
accepted:
18
06
2020
pubmed:
25
7
2020
medline:
2
3
2021
entrez:
25
7
2020
Statut:
ppublish
Résumé
Many Eastern reports attempted to identify predictive variables for esophago-jejunal anastomosis leakage (EJAL) after total gastrectomy for cancer. There are no definitive answers about reliable risk factors for EJAL. This retrospective study shows the largest Western series focused on this topic. This is a multicenter retrospective study analyzing patients' datasets collected by 18 Italian referral Centres of the Italian Research Group for Gastric Cancer (GIRCG) from 2000 to 2018. The inclusion criteria were pathological diagnosis of gastric and esophageal (Siewert III) carcinoma requiring total gastrectomy. The primary end point of risk analysis was the occurrence of EJAL; secondary end points were post-operative (30-day) morbidity and mortality, length of stay (LoS), and survival. Data of 1750 patients submitted to total gastrectomy were collected. EJAL developed in 116 (6.6%) patients and represented the 26.3% of all the 441 observed post-operative surgical complications. EJAL diagnosis was followed by a reoperation in 39 (33.6%) patients and by an endoscopic/radiological procedure in 30 cases (25.9%). In 47 patients (40.5%) EJAL was managed with conservative approach. Post-operative LoS and mortality were significantly higher after EJAL occurrence (27 days versus 12 days and 8.6% versus 1.6%, respectively). At risk analysis, comorbidities (particularly, if respiratory), minimally invasive surgery, extended lymphadenectomy, and anastomotic technique resulted significant predictive factors for EJAL. EJAL did not significantly affect survival. These results were consistent with Asian experiences: the frequency of EJAL and its higher rate observed in patients with comorbidities or after minimally invasive approach were confirmed.
Sections du résumé
BACKGROUND
Many Eastern reports attempted to identify predictive variables for esophago-jejunal anastomosis leakage (EJAL) after total gastrectomy for cancer. There are no definitive answers about reliable risk factors for EJAL. This retrospective study shows the largest Western series focused on this topic.
METHODS
This is a multicenter retrospective study analyzing patients' datasets collected by 18 Italian referral Centres of the Italian Research Group for Gastric Cancer (GIRCG) from 2000 to 2018. The inclusion criteria were pathological diagnosis of gastric and esophageal (Siewert III) carcinoma requiring total gastrectomy. The primary end point of risk analysis was the occurrence of EJAL; secondary end points were post-operative (30-day) morbidity and mortality, length of stay (LoS), and survival.
RESULTS
Data of 1750 patients submitted to total gastrectomy were collected. EJAL developed in 116 (6.6%) patients and represented the 26.3% of all the 441 observed post-operative surgical complications. EJAL diagnosis was followed by a reoperation in 39 (33.6%) patients and by an endoscopic/radiological procedure in 30 cases (25.9%). In 47 patients (40.5%) EJAL was managed with conservative approach. Post-operative LoS and mortality were significantly higher after EJAL occurrence (27 days versus 12 days and 8.6% versus 1.6%, respectively). At risk analysis, comorbidities (particularly, if respiratory), minimally invasive surgery, extended lymphadenectomy, and anastomotic technique resulted significant predictive factors for EJAL. EJAL did not significantly affect survival.
CONCLUSIONS
These results were consistent with Asian experiences: the frequency of EJAL and its higher rate observed in patients with comorbidities or after minimally invasive approach were confirmed.
Identifiants
pubmed: 32703713
pii: S0748-7983(20)30560-6
doi: 10.1016/j.ejso.2020.06.035
pii:
doi:
Types de publication
Journal Article
Multicenter Study
Langues
eng
Sous-ensembles de citation
IM
Pagination
2243-2247Investigateurs
Maria Bencivenga
(M)
Mariagiulia Dal Cero
(M)
Fausto Rosa
(F)
Sergio Alfieri
(S)
Guido Alberto Tiberio
(GA)
Marie Sophie Alfano
(MS)
Monica Gualtierotti
(M)
Giovanni Ferrari
(G)
Roberto Persiani
(R)
Alberto Biondi
(A)
Annibale Donini
(A)
Luigina Graziosi
(L)
Diego Sasia
(D)
Paolo Geretto
(P)
Jacopo Vigano
(J)
Enrico Cicuttin
(E)
Federica Galli
(F)
Paolo Strignano
(P)
Elena Mazza
(E)
Antonio Taddei
(A)
Ilenia Bartolini
(I)
Lucio Taglietti
(L)
Silvia Ruggiero
(S)
Elio Treppiedi
(E)
Vittorio Postiglione
(V)
Francesco Casella
(F)
Andrea Sansonetti
(A)
Carlo Abatini
(C)
Miriam Attalla El Halabieh
(M)
Paolo Millo
(P)
Antonella Usai
(A)
Michela Mineccia
(M)
Alessandro Ferrero
(A)
Informations de copyright
Copyright © 2020 Elsevier Ltd, BASO ~ The Association for Cancer Surgery, and the European Society of Surgical Oncology. All rights reserved.
Déclaration de conflit d'intérêts
Declaration of competing interest None.