Oshi Masanori, Kunisaki Chikara, Miyamoto Hiroshi, Kosaka Takashi, Akiyama Hirotoshi, Endo Itaru
Department of Surgery, Gastroenterological Center, Yokohama City University, Yokohama, Japan.
Dig Surg. 2018;35(1):28-34. doi: 10.1159/000464357. Epub 2017 Apr 26.
BACKGROUND/AIMS: The study aimed to clarify the risk factors for anastomotic leakage after laparoscopy-assisted total gastrectomy (LATG) for gastric cancer.
In this study, we enrolled 131 patients with preoperatively diagnosed early gastric cancer who underwent LATG by a single surgeon between June 2006 and February 2014 at the Department of Surgery, Gastroenterological Center, Yokohama City University. Risk factors for anastomotic leakage (esophagojejunostomy) after LATG were retrospectively evaluated by univariate and multivariate analyses.
Anastomotic leakage of the esophagojejunostomy was observed in 13 (9.9%) of 131 patients. Univariate analysis of risk factors for anastomotic leakage revealed that the prognostic nutritional index (PNI) is a risk factor for anastomotic leakage (<55, 11 of 63 vs. ≥55, 2 of 55; p = 0.039). Multivariate analysis revealed that PNI is an independent risk factor for anastomotic leakage (OR 0.208; 95% CI 0.044-0.981; p = 0.047).
Gastric cancer patients with a low PNI have a higher risk for anastomotic leakage after LATG. The results of this study must be confirmed by a study with a large cohort of patients receiving LATG reconstructed using the same method by experienced surgeons in multiple institutions.
背景/目的：本研究旨在阐明腹腔镜辅助全胃切除术（LATG）治疗胃癌后吻合口漏的危险因素。
本研究纳入了2006年6月至2014年2月间在横滨市立大学胃肠病中心外科由同一位外科医生进行LATG手术的131例术前诊断为早期胃癌的患者。通过单因素和多因素分析对LATG术后吻合口漏（食管空肠吻合）的危险因素进行回顾性评估。
131例患者中有13例（9.9%）发生了食管空肠吻合口漏。吻合口漏危险因素的单因素分析显示，预后营养指数（PNI）是吻合口漏的危险因素（PNI<55时，63例中有11例；PNI≥55时，55例中有2例；p=0.039）。多因素分析显示，PNI是吻合口漏的独立危险因素（OR 0.208；95%CI 0.044 - 0.981；p=0.047）。
PNI低的胃癌患者LATG术后发生吻合口漏的风险较高。本研究结果必须通过一项由多个机构的经验丰富的外科医生使用相同方法对大量接受LATG重建的患者进行的研究来证实。
