Department Surgery, Gyeongsang National University College of Medicine and Gyeongsang National University Hospital, Jinju, South Korea.
Department Surgery, Gyeongsang National University College of Medicine and Gyeongsang National University Changwon Hospital, Changwon, South Korea.
Am Surg. 2023 May;89(5):1405-1413. doi: 10.1177/00031348211050842. Epub 2021 Nov 23.
Reoperation due to elective surgery complications is very mentally, physically, and economically detrimental to patients. This study investigated the potential risk factors associated with early reoperation after radical gastrectomy in gastric cancer patients and included an in-depth analysis of these risk factors.
This retrospective study reviewed 1568 patients with gastric cancer. Grade 3 or greater complications were defined as severe. Any factors related to reoperation after radical gastrectomy were analyzed in patients with severe local complications.
Among 1537 patients undergoing radical gastrectomy, 115 (7.5%) patients had severe postoperative complications, 98 (6.38%) of whom experienced severe local complications. The most common local complication was anastomotic leakage (31, 2.02%), followed by intra-abdominal abscess (30, 1.95%), pancreatic leakage (22, 1.43%), duodenal stump leakage (18, 1.17%), intra-abdominal bleeding (12, .78%), intraluminal bleeding (8, .52%), small bowel obstruction (5, .32%), and chyle leakage (3, .19%). Of these patients, 26 (1.69%) underwent reoperation, and 6 (.39%) died. In the univariate analysis of clinical factors related to reoperation, intra-abdominal bleeding and small bowel obstruction were risk factors for reoperation, and intra-abdominal bleeding (odds ratio [OR] = 9.57, confidence interval [CI] = 2.65-40.20, < .001) and small bowel obstruction (OR = 19.14, CI = 2.60-390.13, = .011) were independent risk factors associated with reoperation in the multivariate analysis.
Intra-abdominal bleeding and small bowel obstruction are independent risk factors for reoperation following radical gastrectomy. Patients with postoperative intra-abdominal bleeding and small bowel obstruction need to be warned about reoperation.
择期手术并发症导致的再次手术对患者的身心和经济都有很大的损害。本研究旨在探讨胃癌根治术后早期再次手术的潜在危险因素，并对这些危险因素进行深入分析。
本回顾性研究纳入了 1568 例胃癌患者。3 级或更高级别的并发症定义为严重并发症。对接受根治性胃切除术的患者中出现严重局部并发症的患者进行了与再次手术相关的任何因素分析。
在 1537 例行根治性胃切除术的患者中，有 115 例（7.5%）患者发生严重术后并发症，其中 98 例（6.38%）患者出现严重局部并发症。最常见的局部并发症是吻合口漏（31 例，2.02%），其次是腹腔脓肿（30 例，1.95%）、胰漏（22 例，1.43%）、十二指肠残端漏（18 例，1.17%）、腹腔内出血（12 例，0.78%）、肠内出血（8 例，0.52%）、小肠梗阻（5 例，0.32%）和乳糜漏（3 例，0.19%）。这些患者中有 26 例（1.69%）进行了再次手术，其中 6 例（0.39%）死亡。在对与再次手术相关的临床因素的单因素分析中，腹腔内出血和小肠梗阻是再次手术的危险因素，腹腔内出血（比值比 [OR] = 9.57，置信区间 [CI] = 2.65-40.20， <.001）和小肠梗阻（OR = 19.14，CI = 2.60-390.13， =.011）是多因素分析中与再次手术相关的独立危险因素。
腹腔内出血和小肠梗阻是胃癌根治术后再次手术的独立危险因素。术后发生腹腔内出血和小肠梗阻的患者需要告知再次手术的风险。
