Department Surgery, Gyeongsang National University Hospital, College of Medicine, Gyeongsang National University, 79 Gangnam-ro, Jinju, Gyeongsang, 62727, South Korea.
Surg Endosc. 2020 Dec;34(12):5312-5319. doi: 10.1007/s00464-019-07319-3. Epub 2019 Dec 13.
Anastomotic complications such as leaks, bleeding, and stricture remain the most serious complications of surgery for gastric cancer. No perfect method exists for an accurate and reliable prevention of these complications. This study investigated the safety and efficacy of post-anastomotic intraoperative endoscopy (PAIOE) for avoidance of early anastomotic complications during gastrectomy in gastric cancer.
This retrospective case-control study enrolled patients from a tertiary care, academic medical center. Routine PAIOE was performed on 319 patients undergoing gastrectomy for gastric cancer between 2015 and 2016. As controls, without PAIOE 270 patients from 2013 to 2014 were used for comparison. Early anastomotic complications and outcomes after PAIOE were determined.
Although there were no differences between the PAIOE and non-PAIOE group in terms of overall complication rates (20.1% vs 26.7%; P > 0.05), there were fewer complications related to anastomosis (3.4% vs 8.9%; P < 0.01) in the PAIOE group. The PAIOE group had rates of 2.5% for anastomotic leakage, 0.9% for intra-luminal bleeding, and 0% for anastomotic stenosis, while the non-PAIOE group exhibited rates of 5.6%, 2.6%, and 0.7%, respectively. Thirty-one abnormalities were detected in 26 PAIOE patients (9.71%) (20 venous bleeding, 7 mucosal tearing, 2 air leaks, 1 arterial bleeding, and 1 anastomotic stricture). All abnormalities were corrected by proper interventions (13 reinforced additional suture, 13 endoscopic hemostasis, and 2 re-anastomosis). There were no morbidities associated with PAIOE.
PAIOE appears to be a safe and reliable procedure to evaluate the stability of gastrointestinal anastomosis for gastric cancer patients. Further data collection and a well-designed prospective study are needed to confirm the validity of PAIOE.
吻合口并发症，如漏、出血和狭窄，仍然是胃癌手术最严重的并发症。目前还没有一种完美的方法可以准确可靠地预防这些并发症。本研究探讨了胃切除术后术中吻合口内镜检查（PAIOE）在预防胃癌术后早期吻合口并发症中的安全性和有效性。
本回顾性病例对照研究纳入了一家三级保健学术医疗中心的患者。2015 年至 2016 年期间，对 319 例胃癌患者行常规 PAIOE。作为对照，2013 年至 2014 年未行 PAIOE 的 270 例患者用于比较。确定 PAIOE 后的早期吻合口并发症和结局。
尽管在总体并发症发生率方面，PAIOE 组（20.1%）与非 PAIOE 组（26.7%）无差异（P>0.05），但 PAIOE 组与吻合口相关的并发症更少（3.4% vs. 8.9%；P<0.01）。PAIOE 组吻合口漏的发生率为 2.5%，腔内出血的发生率为 0.9%，吻合口狭窄的发生率为 0%，而非 PAIOE 组的发生率分别为 5.6%、2.6%和 0.7%。26 例 PAIOE 患者中有 31 例（9.71%）检测到异常（20 例静脉出血，7 例黏膜撕裂，2 例气漏，1 例动脉出血，1 例吻合口狭窄）。所有异常均通过适当的干预措施纠正（13 例加强额外缝合，13 例内镜止血，2 例再吻合）。PAIOE 无相关并发症。
PAIOE 似乎是一种安全可靠的方法，可评估胃癌患者胃肠吻合口的稳定性。需要进一步收集数据并进行精心设计的前瞻性研究，以确认 PAIOE 的有效性。
