Universidade de São Paulo, University Hospital, Faculty of Medicine, Department of Gastroenterology, São Paulo (SP), Brazil.
Arq Bras Cir Dig. 2023 Nov 13;36:e1774. doi: 10.1590/0102-672020230056e1774. eCollection 2023.
The main treatment modality for gastric cancer is surgical resection with lymphadenectomy. Despite advances in perioperative care, major surgical complications can occur in up to 20% of cases. To determine the quality of surgical care employed, a new indicator called failure to rescue (FTR) was proposed, which assesses the percentage of patients who die after complications occur.
To assess the rate of FTR after gastrectomy and factors associated with its occurrence.
Patients with gastric cancer who underwent gastrectomy with curative intent were retrospectively evaluated. According to the occurrence of postoperative complications, patients were divided into FTR group (grade V complications) and rescued group (grade III/IV complications).
Among the 731 patients, 114 had major complications. Of these patients, 76 (66.7%) were successfully treated for the complication (rescued group), while 38 (33.3%) died (FTR group). Patients in the FTR group were older (p=0.008; p<0.05), had lower levels of hemoglobin (p=0.021; p<0.05) and albumin (p=0.002; p<0.05), and a higher frequency of ASA III/IV (p=0.033; p<0.05). There were no differences between the groups regarding surgical and pathological characteristics. Clinical complications had a higher mortality rate (40.0% vs 30.4%), with pulmonary complications (50.2%) and infections (46.2%) being the most lethal. Patients with major complications grade III/IV had worse survival than those without complications.
The FTR rate was 33.3%. Advanced age, worse performance, and nutritional parameters were associated with FTR.
胃癌的主要治疗方式是手术切除和淋巴结清扫。尽管围手术期护理有了进步，但仍有多达 20%的病例会出现重大手术并发症。为了确定所采用的手术护理质量，提出了一个新的指标，称为救援失败（FTR），它评估了并发症发生后死亡的患者比例。
评估胃切除术后 FTR 的发生率以及与 FTR 发生相关的因素。
回顾性评估了接受根治性胃切除术的胃癌患者。根据术后并发症的发生情况，将患者分为 FTR 组（V 级并发症）和获救组（III/IV 级并发症）。
在 731 名患者中，有 114 名发生了主要并发症。在这些患者中，76 名（66.7%）成功治疗了并发症（获救组），而 38 名（33.3%）死亡（FTR 组）。FTR 组患者年龄较大（p=0.008；p<0.05），血红蛋白（p=0.021；p<0.05）和白蛋白（p=0.002；p<0.05）水平较低，ASA 分级 III/IV 发生率较高（p=0.033；p<0.05）。两组在手术和病理特征方面无差异。临床并发症的死亡率较高（40.0%比 30.4%），其中肺部并发症（50.2%）和感染（46.2%）最为致命。有 III/IV 级主要并发症的患者的生存情况比没有并发症的患者差。
FTR 发生率为 33.3%。年龄较大、功能状态较差和营养参数与 FTR 相关。
