Division of Digestive Surgery and Urology, Turku University Hospital, Turku, Finland.
Surgery Research Unit, Medical Research Center Oulu, Oulu University Hospital and University of Oulu, Oulu, Finland.
Ann Surg Oncol. 2024 Aug;31(8):5263-5272. doi: 10.1245/s10434-024-15415-5. Epub 2024 May 15.
The purpose of this study was to examine the rates of 90-day anastomotic complications and other postoperative complications after total or partial gastrectomy with antecolic versus retrocolic reconstruction in a population-based setting.
This population-based nationwide retrospective cohort study included all patients undergoing total or partial gastrectomy for gastric adenocarcinoma in Finland in 2005-2016, with follow-up until 31 December 2019. Logistic regression provided odds ratios (ORs) with 95% confidence intervals (CIs) of 90-day mortality. Results were adjusted for age, sex, year of the surgery, comorbidities, tumor locations, pathological stage, and neoadjuvant therapy.
A total of 2063 patients having gastrectomy with antecolic (n = 814) or retrocolic (n = 1249) reconstruction were identified from the registries. The anastomotic complication rate was 3.8% with antecolic reconstruction and 5.0% with retrocolic reconstruction. Antecolic reconstruction was not associated with a higher risk of anastomotic complications compared with retrocolic reconstruction in the adjusted analysis (OR 0.69, 95% CI 0.44-1.09) of the whole cohort or in the predefined subgroups. The reoperation rate was 8.2% with antecolic reconstruction and 7.7% with retrocolic reconstruction, without statistical significance. In subgroup analysis of total gastrectomy patients, the risk of major complications was lower with antecolic reconstruction compared with retrocolic reconstruction (OR 0.62, 95% CI 0.45-0.86).
The rate of anastomotic complications did not differ after antecolic versus retrocolic reconstruction after total or partial gastrectomy. In total gastrectomies, the risk of major complications was lower after antecolic compared with retrocolic reconstruction.
本研究旨在人群基础上，检查全胃或部分胃切除术后采用结肠前与结肠后吻合的 90 天吻合口并发症和其他术后并发症的发生率。
本基于人群的全国性回顾性队列研究纳入了 2005 年至 2016 年期间在芬兰因胃腺癌接受全胃或部分胃切除术的所有患者，并随访至 2019 年 12 月 31 日。Logistic 回归提供了 90 天死亡率的比值比（OR）及其 95%置信区间（CI）。结果针对年龄、性别、手术年份、合并症、肿瘤位置、病理分期和新辅助治疗进行了调整。
从登记处确定了 2063 例接受结肠前（n=814）或结肠后（n=1249）重建的胃切除术患者。结肠前重建的吻合口并发症发生率为 3.8%，结肠后重建的吻合口并发症发生率为 5.0%。在整个队列或预先定义的亚组的调整分析中，结肠前重建与结肠后重建相比，吻合口并发症的风险没有更高（OR 0.69，95%CI 0.44-1.09）。结肠前重建的再次手术率为 8.2%，结肠后重建的再次手术率为 7.7%，无统计学意义。全胃切除术患者的亚组分析中，结肠前重建的主要并发症风险低于结肠后重建（OR 0.62，95%CI 0.45-0.86）。
全胃或部分胃切除术后，结肠前与结肠后吻合的吻合口并发症发生率没有差异。在全胃切除术患者中，结肠前重建的主要并发症风险低于结肠后重建。
