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Incidence and treatment outcomes of leakage after gastrectomy for gastric cancer: Experience of 14,075 patients from a large volume centre

Authors
 Chul Kyu Roh  ;  Seohee Choi  ;  Won Jun Seo  ;  Minah Cho  ;  Hyoung-Il Kim  ;  Sang-Kil Lee  ;  Joon Seok Lim  ;  Woo Jin Hyung 
Citation
 EJSO, Vol.47(9) : 2304-2312, 2021-09 
Journal Title
EJSO
ISSN
 0748-7983 
Issue Date
2021-09
MeSH
Aged ; Anastomotic Leak / epidemiology* ; Anastomotic Leak / mortality ; Anastomotic Leak / therapy* ; Esophagogastric Junction ; Female ; Gastrectomy / statistics & numerical data* ; Hospitals, High-Volume / statistics & numerical data ; Humans ; Incidence ; Laparoscopy / statistics & numerical data ; Male ; Middle Aged ; Republic of Korea / epidemiology ; Retrospective Studies ; Risk Factors ; Robotic Surgical Procedures / statistics & numerical data ; Stomach Neoplasms / surgery* ; Time Factors ; Treatment Outcome
Keywords
Gastrectomy ; Gastric cancer ; Incidence ; Leakage ; Treatment outcome
Abstract
Introduction: Leakage is a serious and potentially fatal complication of gastrectomy for gastric cancer. However, comprehensive reports regarding leakage after gastrectomy remain limited. We aimed to evaluate the incidence and treatment outcomes of leakage after gastrectomy for cancer.

Methods: We reviewed the prospectively collected data of 14,075 Patients who underwent gastrectomy for gastric cancer between 2005 and 2017. Outcomes included incidence, risk factors of leakage, and leakage treatment outcomes.

Results: The median day of leakage detection was postoperative day 7 (range 1-29days). The overall leakage incidence was 1.51% (213/14,075), and the most frequent location was the oesophagojejunostomy (2.07%). Leakage after total gastrectomy was more frequent with minimally invasive surgery (open:1.64%, laparoscopic:3.56%, robotic:5.83%; P < 0.001). Leakage incidence was higher in the surgeon's initial 100 cases than in later cases (2.4 vs. 1.3%; P < 0.001), especially with minimally invasive surgery. Early leakage (within 4 days of surgery) occurred more often after minimally invasive surgery (open:12.7%, laparoscopic:35.4%, robotic:29.0%; P = 0.006). The success rate for initial treatment of leakage was 70.4% (150/213). Surgery after initial treatment failure demonstrated a higher success rate for early leakage than for late leakage (80.0 vs. 22.2%). Among 213 patients who experienced leakage, fifteen patients (7.0%) died, and leakage-related mortality accounted for 38.5% (15/39) of all surgery-related mortality after gastrectomy.

Conclusions: Leakage after gastric cancer surgery is associated with high mortality. Improved surgeon experience using minimally invasive techniques is required to reduce the risk of leakage. Surgery is an effective treatment for early leakage, although further studies are needed to establish the most appropriate treatment strategies.
Full Text
https://www.sciencedirect.com/science/article/pii/S0748798321001049
DOI
10.1016/j.ejso.2021.02.013
Appears in Collections:
1. College of Medicine (의과대학) > Dept. of Internal Medicine (내과학교실) > 1. Journal Papers
1. College of Medicine (의과대학) > Dept. of Radiology (영상의학교실) > 1. Journal Papers
1. College of Medicine (의과대학) > Dept. of Surgery (외과학교실) > 1. Journal Papers
Yonsei Authors
Kim, Hyoung Il(김형일) ORCID logo https://orcid.org/0000-0002-6134-4523
Seo, Won Jun(서원준)
Lee, Sang Kil(이상길) ORCID logo https://orcid.org/0000-0002-0721-0364
Lim, Joon Seok(임준석) ORCID logo https://orcid.org/0000-0002-0334-5042
Cho, Minah(조민아) ORCID logo https://orcid.org/0000-0003-3011-5813
Choi, Seo Hee(최서희)
Hyung, Woo Jin(형우진) ORCID logo https://orcid.org/0000-0002-8593-9214
URI
https://ir.ymlib.yonsei.ac.kr/handle/22282913/190504
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