Paul Palmer1, Michael Egger1, Prejesh Philips1, Kelly M McMasters1, Charles R Scoggins1, Robert C G Martin2. 1. All Authors: University of Louisville, Division of Surgical Oncology, Hiram C Polk Jr Department of Surgery, Louisville, KY, USA. 2. All Authors: University of Louisville, Division of Surgical Oncology, Hiram C Polk Jr Department of Surgery, Louisville, KY, USA. Electronic address: Robert.Martin@louisville.edu.
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.
BACKGROUND: The preoperative and intraoperative factors that could predict a higher risk of anastomotic/staple line leak for gastric cancerpatients 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 adenocarcinomapatients 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.