Section of Surgical Endoscopy, Department of General Surgery, Cleveland Clinic Foundation, 9500 Euclid Avenue, A-100, Cleveland, OH, 44195, USA.
Department of Surgery, George Washington University, Washington, DC, USA.
J Gastrointest Surg. 2017 Oct;21(10):1577-1583. doi: 10.1007/s11605-017-3496-9. Epub 2017 Jul 25.
In addition to increased perioperative morbidity, anastomotic leak following gastric resection for gastric cancer can have detrimental effects on overall and disease-free survival. The risk of anastomotic leak following neoadjuvant therapy remains unknown. The purpose of this study is to investigate the association of preoperative chemotherapy and radiation therapy with postoperative anastomotic leak and additional 30-day morbidity and mortality outcomes following total gastrectomy with reconstruction for gastric cancer using the American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP).
Patients who underwent total gastrectomy with reconstruction for gastric cancer from 2005 to 2012 were identified. Within the NSQIP database, anastomotic leak is captured as an organ space infection. The association of preoperative chemotherapy and radiation therapy with anastomotic leak and additional 30-day morbidity and mortality outcomes was investigated using chi-squared analysis, Fisher's exact test, and Student's t test.
A total of 1135 patients met inclusion criteria; 121 (10.7%) patients underwent preoperative chemotherapy within 30 days of surgery, and 53 (4.7%) patients underwent preoperative radiation therapy within 90 days of surgery. Neither preoperative chemotherapy nor radiation therapy was associated with an increased risk of anastomotic leak (p = 0.12 and p = 0.58, respectively). When compared to patients who did not undergo neoadjuvant therapy, patients who underwent either preoperative chemotherapy or radiation therapy did not experience a higher frequency of 30-day mortality (p = 0.41), cardiac (p = 0.49), wound (p = 0.76), renal (p = 0.13), septic (p = 0.55), or venous thromboembolism (p = 0.19) events and were significantly less likely to experience a pulmonary event (p = 0.02).
Neoadjuvant therapy prior to gastric resection for gastric cancer is not associated with an increased risk of anastomotic leak or other additional short-term morbidity or mortality.
除了围手术期发病率增加外，胃癌胃切除术后吻合口漏还会对总生存和无病生存产生不利影响。新辅助治疗后吻合口漏的风险尚不清楚。本研究旨在通过美国外科医师学院国家外科质量改进计划（ACS-NSQIP）调查术前化疗和放疗与胃癌全胃切除术后吻合口漏及其他 30 天发病率和死亡率的关系。
确定了 2005 年至 2012 年间接受全胃切除加重建治疗的胃癌患者。在 NSQIP 数据库中，吻合口漏被捕获为器官空间感染。采用卡方检验、Fisher 确切检验和 Student t 检验，研究术前化疗和放疗与吻合口漏及其他 30 天发病率和死亡率的关系。
共有 1135 例患者符合纳入标准；121 例（10.7%）患者在手术前 30 天内接受术前化疗，53 例（4.7%）患者在手术前 90 天内接受术前放疗。术前化疗和放疗均与吻合口漏风险增加无关（p=0.12 和 p=0.58）。与未接受新辅助治疗的患者相比，接受术前化疗或放疗的患者 30 天死亡率（p=0.41）、心脏（p=0.49）、伤口（p=0.76）、肾脏（p=0.13）、感染（p=0.55）或静脉血栓栓塞（p=0.19）事件的发生率均无明显升高，而肺部事件的发生率明显降低（p=0.02）。
胃癌胃切除术前新辅助治疗与吻合口漏或其他短期发病率或死亡率增加无关。
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