Marco Baia1, Lorenzo Conti2, Sandro Pasquali1, Catherine Sarre-Lazcano1, Carlo Abatini1, Stefano Piero Bernardo Cioffi1, Serena Della Valle3, Giorgio Greco4, Raffaella Vigorito4, Amanda Casirati3, Paolo Proto5, Cecilia Gavazzi3, Alessandro Gronchi1, Marco Fiore6. 1. Sarcoma Service, Department of Surgery, IRCCS Fondazione Istituto Nazionale dei Tumori di Milano, Milan, Italy. 2. Ospedale Galmarini di Tradate - ASST Settelaghi, Varese, Tradate, Italy. 3. Clinical Nutritional Service, IRCCS Fondazione Istituto Nazionale dei Tumori di Milano, Milan, Italy. 4. Department of Radiology, IRCCS Fondazione Istituto Nazionale dei Tumori di Milano, Milan, Italy. 5. Anesthesiology Department, IRCCS Fondazione Istituto Nazionale dei Tumori di Milano, Milan, Italy. 6. Sarcoma Service, Department of Surgery, IRCCS Fondazione Istituto Nazionale dei Tumori di Milano, Milan, Italy. marco.fiore@istitutotumori.mi.it.
Abstract
INTRODUCTION: Delayed gastric emptying (DGE) is a common complication in surgery, but incidence and relevance following multivisceral resection are unknown. METHODS: Data from 100 consecutive patients treated for primary retroperitoneal sarcoma (RPS) were analyzed from our institutional prospectively maintained database from January 2019 to April 2020. DGE severity was graded according to the International Study Group of Pancreatic Surgery and classified as primary or secondary to other complications. The primary outcome was incidence and grade of clinically relevant DGE (grades B-C). Secondary outcomes were correlation with patient, tumor, and treatment characteristics, and non-DGE morbidity [Clavien-Dindo (CD) grade ≥ 3]. RESULTS: Forty-two patients developed DGE and 28 had clinically relevant DGE. DGE was primary in 10 patients and secondary in 18 patients; the most common associated complications were: infections (11/18, 61.1%), pancreatic leak (7/18, 38.9%), bleeding (6/18, 33.3%), and bowel leak (6/18, 33.3%). DGE was related to longer length of hospital stay (P < 0.001), ICU admission (P = 0.004), ICU length of stay (P = 0.001), postoperative complications (CD [Formula: see text] 3 in 14/28 in DGE patients vs 11/72 in no-DGE; P = 0.04), and re-operation (P = 0.03). With multivariate analysis, the independent risk factors for DGE were patient comorbidities (OR 1.05; 95% CI 1.01-1.1; P = 0.04) and tumor size (OR 1.05; 95% CI 1.0-1.1; P = 0.02). DISCUSSION: Following multivisceral resection, DGE is a clinically relevant event that can be caused by an underlying complication. Prompt diagnosis and treatment of both DGE and any underlying complications led to full recovery in all cases.
INTRODUCTION: Delayed gastric emptying (DGE) is a common complication in surgery, but incidence and relevance following multivisceral resection are unknown. METHODS: Data from 100 consecutive patients treated for primary retroperitoneal sarcoma (RPS) were analyzed from our institutional prospectively maintained database from January 2019 to April 2020. DGE severity was graded according to the International Study Group of Pancreatic Surgery and classified as primary or secondary to other complications. The primary outcome was incidence and grade of clinically relevant DGE (grades B-C). Secondary outcomes were correlation with patient, tumor, and treatment characteristics, and non-DGE morbidity [Clavien-Dindo (CD) grade ≥ 3]. RESULTS: Forty-two patients developed DGE and 28 had clinically relevant DGE. DGE was primary in 10 patients and secondary in 18 patients; the most common associated complications were: infections (11/18, 61.1%), pancreatic leak (7/18, 38.9%), bleeding (6/18, 33.3%), and bowel leak (6/18, 33.3%). DGE was related to longer length of hospital stay (P < 0.001), ICU admission (P = 0.004), ICU length of stay (P = 0.001), postoperative complications (CD [Formula: see text] 3 in 14/28 in DGE patients vs 11/72 in no-DGE; P = 0.04), and re-operation (P = 0.03). With multivariate analysis, the independent risk factors for DGE were patient comorbidities (OR 1.05; 95% CI 1.01-1.1; P = 0.04) and tumor size (OR 1.05; 95% CI 1.0-1.1; P = 0.02). DISCUSSION: Following multivisceral resection, DGE is a clinically relevant event that can be caused by an underlying complication. Prompt diagnosis and treatment of both DGE and any underlying complications led to full recovery in all cases.
Authors: Nissar Shaikh; M M Nainthramveetil; Shoaib Nawaz; Jazib Hassan; Ahmed A Shible; Edin Karic; Rajvir Singh; Muna Al Maslamani Journal: Qatar Med J Date: 2021-01-12