Ciesielski Maciej, Kruszewski Wiesław J, Walczak Jakub, Szajewski Mariusz, Szefel Jarosław, Wydra Jacek, Buczek Tomasz, Czerepko Maksymilian
Department of Oncological Surgery, Gdynia Oncology Centre, Gdynia, Poland.
Division of Propaedeutics of Oncology, Medical University of Gdansk, Gdansk, Poland.
Prz Gastroenterol. 2017;12(3):215-221. doi: 10.5114/pg.2017.70475. Epub 2017 Sep 30.
Surgical resection is the only potentially curative modality for gastric cancer and it is associated with substantial morbidity and mortality.
To determine risk factors for postoperative morbidity and mortality following major surgery for gastric cancer.
Between 1.08.2006 and 30.11.2014 in the Department of Oncological Surgery of Gdynia Oncology Centre 162 patients underwent gastric resection for adenocarcinoma. All procedures were performed by 13 surgeons. Five of them performed at least two gastrectomies per year ( = 106). The remaining 56 resections were done by eight surgeons with annual volume lower than two. Perioperative mortality was defined as every in-hospital death and death within 30 days after surgery. Causes of perioperative deaths were the matter of in-depth analysis.
Overall morbidity was 23.5%, including 4.3% rate of proximal anastomosis leak. Mortality rate was 4.3%. Morbidity and mortality were not dependent on: age, gender, body mass index, tumour location, extent of surgery, splenectomy performance, or pTNM stage. The rates of morbidity (50% vs. 21.3%) and mortality (16.7% vs. 3.3%) were significantly higher in cases of tumour infiltration to adjacent organs (pT4b). Perioperative morbidity and mortality were 37.5% and 8.9% for surgeons performing less than two gastrectomies per year and 16% and 0.9% for surgeons performing more than two resections annually. The differences were statistically significant ( = 0.002, = 0.003).
Annual surgeon case load and adjacent organ infiltration (pT4b) were significant risk factors for morbidity and mortality following major surgery for gastric cancer. The most common complications leading to perioperative death were cardiac failure and proximal anastomosis leak.
手术切除是胃癌唯一可能治愈的方式，但它会带来较高的发病率和死亡率。
确定胃癌大手术后术后发病和死亡的风险因素。
2006年8月1日至2014年11月30日期间，格丁尼亚肿瘤中心肿瘤外科有162例患者接受了腺癌胃切除术。所有手术均由13名外科医生完成。其中5名医生每年至少进行2例胃切除术（n = 106）。其余56例切除术由8名年手术量低于2例的医生完成。围手术期死亡率定义为所有住院死亡及术后30天内死亡。围手术期死亡原因进行了深入分析。
总体发病率为23.5%，其中近端吻合口漏发生率为4.3%。死亡率为4.3%。发病率和死亡率不取决于：年龄、性别、体重指数、肿瘤位置、手术范围、脾切除术、或pTNM分期。肿瘤侵犯相邻器官（pT4b）的病例中，发病率（50%对21.3%）和死亡率（16.7%对3.3%）显著更高。每年进行少于2例胃切除术的外科医生，围手术期发病率和死亡率分别为37.5%和8.9%；每年进行超过2例切除术的外科医生，围手术期发病率和死亡率分别为16%和0.9%。差异具有统计学意义（p = 0.002，p = 0.003）。
外科医生的年手术量及相邻器官侵犯（pT4b）是胃癌大手术后发病和死亡的重要风险因素。导致围手术期死亡的最常见并发症是心力衰竭和近端吻合口漏。
