Renza Trapani1, Stefano Rausei2, Rossella Reddavid3, Maurizio Degiuli4. 1. Surgical Oncology and Digestive Surgery Unit, Department of Oncology of San Luigi University Hospital of Orbassano, Orbassano, Turin, Italy. Electronic address: renza.trapani@gmail.com. 2. Department of Surgery, ASST Valle Olona, Gallarate, Varese, Italy. Electronic address: stefano.rausei@gmail.com. 3. Surgical Oncology and Digestive Surgery Unit, Department of Oncology of San Luigi University Hospital of Orbassano, Orbassano, Turin, Italy. Electronic address: rossella.reddavid@gmail.com. 4. Surgical Oncology and Digestive Surgery Unit, Department of Oncology of San Luigi University Hospital of Orbassano, Orbassano, Turin, Italy. Electronic address: maurizio.degiuli@unito.it.
Abstract
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.
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.
Authors: Umberto Bracale; Roberto Peltrini; Marcello De Luca; Mariangela Ilardi; Maria Michela Di Nuzzo; Alberto Sartori; Maurizio Sodo; Michele Danzi; Francesco Corcione; Carlo De Werra Journal: J Clin Med Date: 2022-08-26 Impact factor: 4.964