Shaganti Rakesh, Kumar Godara Sunil, Kumar Singh Rajneesh, R Rahul, Misra Shagun, Kumar Shaleen
Department of Surgical Gastroenterology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, India.
Department of Radiotherapy, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, India.
Turk J Surg. 2024 Jun 28;40(2):111-118. doi: 10.47717/turkjsurg.2024.6351. eCollection 2024 Jun.
Gastrectomy for cancer is a technically demanding surgery and anastomotic leak is an important complication of this surgery. This study aimed to identify the factors associated with anastomotic leak following gastrectomy in gastric cancer patients and its long-term effect on outcomes.
This is an ambispective study of 181 patients who underwent curative gastrectomy for gastric adenocarcinoma over 13 years, at our institution. Groups with and without anastomotic leak were compared using the Mann-Whitney U test (continuous variables) and Chi-square test (categorical variables). A multivariable analysis was performed to determine the factors associated with anastomotic leak.
Out of the 181 patients who underwent curative gastrectomy, 12 (6.6%) patients experienced anastomotic leak. A multivariable analysis revealed that younger age, presence of comorbidities, hypoalbuminemia, tumor location in the proximal stomach, type of reconstruction, and positive margin status were associating factors for anastomotic leak. During a median follow-up of 34 months (ranging from 12 to 130), it was observed that 25 (18.3%) patients developed anastomotic stenosis, but it was not related to anastomotic leak. The incidence of post-operative pulmonary complications, administration of adjuvant therapy, recurrence rates, and mortality due to anastomotic leak did not significantly change. Moreover, neoadjuvant therapy did not increase the incidence of anastomotic leaks.
Factors like younger age, presence of comorbidities, hypoalbuminemia, tumor location in the proximal stomach, type of reconstruction, and positive margin status were associated with increased risk of anastomotic leak, which needs further studies to validate the findings. Thus, preoperative optimization and resection with adequate margins may be of utmost importance in preventing anastomotic leaks.
胃癌胃切除术是一项技术要求较高的手术，吻合口漏是该手术的一项重要并发症。本研究旨在确定胃癌患者胃切除术后吻合口漏的相关因素及其对预后的长期影响。
这是一项对我院13年间接受根治性胃腺癌胃切除术的181例患者进行的双向研究。使用Mann-Whitney U检验（连续变量）和卡方检验（分类变量）对有和无吻合口漏的组进行比较。进行多变量分析以确定与吻合口漏相关的因素。
在181例行根治性胃切除术的患者中，12例（6.6%）发生吻合口漏。多变量分析显示，年龄较小、存在合并症、低蛋白血症、肿瘤位于胃近端、重建类型和切缘阳性状态是吻合口漏的相关因素。在中位随访34个月（范围为12至130个月）期间，观察到25例（18.3%）患者发生吻合口狭窄，但与吻合口漏无关。术后肺部并发症的发生率、辅助治疗的应用、复发率以及因吻合口漏导致的死亡率没有显著变化。此外，新辅助治疗并未增加吻合口漏的发生率。
年龄较小、存在合并症、低蛋白血症、肿瘤位于胃近端、重建类型和切缘阳性状态等因素与吻合口漏风险增加相关，这需要进一步研究来验证这些发现。因此，术前优化和足够切缘的切除对于预防吻合口漏可能至关重要。
