Nevo Yehonatan, Goldes Yuri, Barda Liran, Nadler Roy, Gutman Mordechai, Nevler Avinoam
Department of General Surgery and Transplantation, Sheba Medical Center, Tel Hashomer, Israel.
Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.
Isr Med Assoc J. 2018 May;20(5):277-280.
Recent studies have analyzed risk factors associated with complications after gastric cancer surgery using the Clavien-Dindo classification (CD). However, they have been based on Asian population cohorts (Chinese, Japanese, Korean).
To prospectively analyze all post-gastrectomy complications according to severity using CD classification and identify postoperative risk factors and complications.
We analyzed all gastrectomies for gastric cancer performed 2009-2014. Recorded parameters included demographic data, existing co-morbidities, neo-adjuvant treatment, intra-operative findings, postoperative course, and histologic findings. Postoperative complications were graded using CD classification.
The study comprised 112 patients who underwent gastrectomy. Mean age was 64.8 ± 12.8 years; 53 patients (47%) underwent gastrectomy, 37 (34%) total gastrectomy, and 22 (19%) total extended gastrectomy. All patients had D2 lymphadenectomy. The average number of retrieved lymph nodes was 35 ± 17. Severe complication rate (≥ IIIa) was 14% and mortality rate was 1.8%. In a univariate analysis, age > 65 years; ASA 3 or higher; chronic renal failure; multi-organ resection; and tumor, node, and metastases (TNM) stage ≥ IIIc were found to be significantly associated with CD complication grade > III (P = 0.01, P = 0.05, P = 0.04, P = 0.04, and P = 0.01, respectively). Multivariate regression analysis revealed advanced stage (≥ IIIc) and age > 65 years to be significant independent risk factors (P < 0.05).
Age > 65 and advanced stage (≥ IIIc) were the primary risk factors for complications of grade > III according to the CD classification following gastrectomy for gastric cancer.
近期研究使用Clavien-Dindo分类法（CD）分析了胃癌手术后并发症的相关危险因素。然而，这些研究均基于亚洲人群队列（中国、日本、韩国）。
使用CD分类法根据严重程度对所有胃切除术后并发症进行前瞻性分析，并确定术后危险因素和并发症。
我们分析了2009年至2014年期间所有因胃癌进行的胃切除术。记录的参数包括人口统计学数据、现有合并症、新辅助治疗、术中发现、术后病程和组织学发现。术后并发症采用CD分类法分级。
该研究纳入了112例行胃切除术的患者。平均年龄为64.8±12.8岁；53例（47%）行胃部分切除术，37例（34%）行全胃切除术，22例（19%）行全胃扩大切除术。所有患者均行D2淋巴结清扫术。平均清扫淋巴结数为35±17枚。严重并发症发生率（≥Ⅲa级）为14%，死亡率为1.8%。单因素分析发现，年龄>65岁、美国麻醉医师协会（ASA）分级为3级或更高、慢性肾功能衰竭、多器官切除以及肿瘤、淋巴结、转移（TNM）分期≥Ⅲc与CD并发症分级>Ⅲ级显著相关（P分别为0.01、0.05、0.04、0.04和0.01）。多因素回归分析显示，晚期（≥Ⅲc）和年龄>65岁是显著的独立危险因素（P<0.05）。
根据CD分类法，年龄>65岁和晚期（≥Ⅲc）是胃癌胃切除术后Ⅲ级以上并发症的主要危险因素。
