Department of General Surgery, The Affiliated Nanchong Central Hospital of North Sichuan Medical College (University), Nanchong.
Department of General Surgery, The First People's Hospital Shuangliu District, Chengdu[West China (Airport) Hospital Sichuan University], Chengdu, Sichuan, China.
Surg Laparosc Endosc Percutan Tech. 2023 Jun 1;33(3):224-230. doi: 10.1097/SLE.0000000000001171.
Anastomotic leakage following a radical gastrectomy is a serious complication of gastric cancer and esophagogastric junction cancer. The benefit of intraoperative leak testing for the prevention of postoperative anastomotic leakage has been controversial. We introduce a new procedure, which combines the techniques of gastroscopy, air, and methylene blue (GAM) for intraoperative leakage testing. Our objective was to evaluate the efficacy and safety of the GAM procedure for intraoperative leak testing and to compare the surgical complications of gastric cancer patients who underwent gastrectomy with and without intraoperative leak testing using the GAM procedure.
A total of 210 patients who underwent radical gastrectomy for gastric cancer were included. Patients were divided into 2 groups: the intraoperative leak testing group using the GAM procedure (IOLT), and the group for which no intraoperative leak testing was done (NIOLT). Clinical and pathologic characteristics, the incidence of postoperative anastomotic leakage, and other surgical complications were compared between the 2 groups.
There were 82 patients in the IOLT group and 82 patients in the NIOLT group after propensity score matching. In the IOLT group, 4 (4.9%) patients were found to have anastomotic discontinuity during the operation; we repaired these anastomotic discontinuities intraoperatively. The incidence of postoperative anastomotic leakage was higher in the NIOLT group compared with the IOLT group, 6 (7.3%) versus 0 (0%), respectively ( P =0.01). The average time of the GAM procedure was 4.99±1.75 minutes. The surgical time was prolonged by 30 minutes in the IOLT group compared with the NIOLT group, 302.2±79.9 versus 272.1±85.2, respectively ( P =0.02). The length of hospital stay, 15.80±4.55 versus 17.00±6.20 ( P =0.16) was reduced in the IOLT group compared with the NIOLT group. The logistic regression model suggested that IOLT, sex, age, Eastern Cooperative Oncology Group, cT stage, tumor diameter, pT stage, pN stage, and Lauren classification were not risk factors for postoperative complication.
The GAM procedure of intraoperative leakage testing can effectively reduce the incidence of postoperative anastomotic leakage in gastric cancer patients undergoing gastrectomy.
根治性胃切除术后吻合口漏是胃癌和食管胃结合部癌的严重并发症。术中漏诊试验预防术后吻合口漏的益处一直存在争议。我们介绍了一种新的方法，即结合胃镜、空气和亚甲蓝（GAM）技术进行术中漏诊试验。我们的目的是评估 GAM 术中漏诊试验的疗效和安全性，并比较接受胃切除术的胃癌患者在使用和不使用 GAM 术中漏诊试验的情况下手术并发症的差异。
共纳入 210 例接受根治性胃切除术的胃癌患者。患者分为两组：使用 GAM 术中漏诊试验（IOLT）组和未行术中漏诊试验组（NIOLT）。比较两组的临床病理特征、术后吻合口漏的发生率和其他手术并发症。
经倾向评分匹配后，IOLT 组有 82 例患者，NIOLT 组有 82 例患者。在 IOLT 组中，4 例（4.9%）患者术中发现吻合口连续性中断，我们术中修复了这些吻合口连续性中断。与 IOLT 组相比，NIOLT 组术后吻合口漏的发生率更高，分别为 6（7.3%）例和 0（0%）例（P=0.01）。GAM 程序的平均时间为 4.99±1.75 分钟。IOLT 组的手术时间比 NIOLT 组延长了 30 分钟，分别为 302.2±79.9 分钟和 272.1±85.2 分钟（P=0.02）。与 NIOLT 组相比，IOLT 组的住院时间更短，分别为 15.80±4.55 天和 17.00±6.20 天（P=0.16）。逻辑回归模型提示，IOLT、性别、年龄、东部肿瘤协作组、cT 分期、肿瘤直径、pT 分期、pN 分期和Lauren 分类不是术后并发症的危险因素。
GAM 术中漏诊试验可有效降低胃癌患者胃切除术后吻合口漏的发生率。
