Clinical implication of positive oral contrast CT for the evaluation of postoperative leakage after gastrectomy for gastric cancer

Abstract

Purpose: The aim of this study was to evaluate the clinical usefulness of positive oral contrast CT for the detection of leakage and its relationship with the immediate postoperative outcome after a gastrectomy for gastric cancer.Materials and Methods: A total of 210 patients with a clinical suspicion of leakage after a gastrectomy for gastric cancer underwent a positive oral contrast CT, and the results were retrospectively analyzed. Two radiologists reviewed the CT images, recorded the presence of extraluminal contrast leakage, and graded the amount of leaked contrast. The rate of postoperative intervention treatment, the length of postoperative hospital stay, and mortality rates were correlated with the presence and grades of leakage. Matching accuracy between CT and other diagnostic studies in detection of leakage was also evaluated.Results: There were 162 patients without extraluminal contrast leakage (77.1%), 13 with grade 1 leakage (6.2%), 19 with grade 2 (9.0%), and 16 with grade 3 (7.6%). The postoperative intervention rate, the hospital stay, and the mortality were significantly higher in patients with visible leakage than in those without visible leakage (p<0.05). The postoperative hospital stays increased as the leakage grades increased (p=0.0008). The matching accuracy between the CT and other studies was 82.1% (n=32/39).Conclusions: Positive oral contrast CT is a reliable tool for diagnosing leakage after a gastrectomy in gastric cancer patients, and the immediate postoperative outcome may be related with the grade of leaked contrast on the CT.