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©The Author(s) 2019.
World J Gastroenterol. Jan 14, 2019; 25(2): 258-268
Published online Jan 14, 2019. doi: 10.3748/wjg.v25.i2.258
Published online Jan 14, 2019. doi: 10.3748/wjg.v25.i2.258
Table 1 Characteristics of patients who underwent R0 resection for gastric cancer n (%)
Characteristic | All patients (n = 4173) | 2009-2013 (n = 2219) | 2014-2016 (n = 1954) | P-value |
Mean age, yr | 0.148 | |||
< 65 | 2701 (64.7) | 1414 (63.7) | 1287 (65.9) | |
≥ 65 | 1472 (35.3) | 805 (36.3) | 667 (34.1) | |
Sex | 0.002 | |||
Male | 3083 (73.9) | 1683 (75.8) | 1400 (71.6) | |
Female | 1090 (26.1) | 536 (24.2) | 554 (28.4) | |
Mean BMI, kg/m2 (SD) | 22.3 (5.2) | 22.0 (3.1) | 22.6 (3.7) | < 0.001 |
History of abdominal surgery | 0.436 | |||
No | 3543 (84.9) | 1875 (84.5) | 1668 (85.4) | |
Yes | 630 (15.1) | 344 (15.5) | 286 (14.6) | |
Tumor site | < 0.001 | |||
Upper | 1136 (27.2) | 590 (26.6) | 546 (27.9) | |
Middle | 892 (21.4) | 383 (17.3) | 509 (26.0) | |
Lower | 1654 (39.6) | 958 (43.2) | 696 (35.6) | |
≥ 2 areas | 491 (11.8) | 288 (13.0) | 203 (10.4) | |
Malnourished | 0.277 | |||
No | 3730 (89.4) | 1919 (88.9) | 1811 (89.9)) | |
Yes | 443 (10.6) | 240 (11.1) | 203 (10.1) | |
Mean tumor size, cm (SD) | 4.4 (2.6) | 4.6 (2.6) | 4.0 (2.7) | < 0.001 |
AJCC-TNM stage, 8th edition | < 0.001 | |||
I | 1158 (27.7) | 598 (26.9) | 560 (28.7) | |
II | 1052 (25.2) | 487 (21.9) | 565 (28.9) | |
III | 1963 (47.0) | 1134 (51.1) | 829 (42.4) | |
Comorbidities | 0.112 | |||
No | 2876 (68.9) | 1553 (70.0) | 1323 (67.7) | |
Yes | 1297 (31.1) | 666 (30.0) | 631 (32.3) | |
HB, g/dL | 0.317 | |||
≥ 90 | 3718 (89.1) | 1967 (88.6) | 1751 (89.6) | |
< 90 | 455 (10.9) | 252 (11.4) | 203 (10.4) | |
ASA | 0.641 | |||
I-II | 4000 (95.9) | 2130 (96.0) | 1870 (95.7) | |
III-IV | 173 (4.1) | 89 (4.0) | 84 (4.3) | |
Operation method | < 0.001 | |||
Open | 670 (16.1) | 469 (21.1) | 201 (10.3) | |
Laparoscopic | 3503 (83.9) | 1750 (78.9) | 1753 (89.7) | |
Type of resection | 0.235 | |||
Subtotal gastrectomy | 1873 (44.9) | 1015 (45.7) | 858 (43.9) | |
Total gastrectomy | 2300 (55.1) | 1204 (54.3) | 1096 (56.1) | |
Type of reconstruction | < 0.001 | |||
Billroth I | 1100 (26.4) | 782 (35.2) | 318 (16.3) | |
Billroth II | 540 (12.9) | 160 (7.2) | 380 (19.4) | |
Roux-en-Y | 2468 (59.1) | 1225 (55.2) | 1243 (63.6) | |
Other | 65 (1.6) | 52 (2.3) | 13 (0.7) | |
Mean surgical duration, min (SD) | 184.7 (67.6) | 191.3 (67.8) | 177.1 (66.7) | < 0.001 |
Mean intraoperative blood loss, mL (SD) | 94.7 (256.8) | 115.0 (335.3) | 71.5 (108.6) | < 0.001 |
Mean length of stay, d (SD) | 13.5 (7.8) | 13.5 (7.4) | 13.4 (8.2) | 0.296 |
AL | 83 (2.0) | 37 (1.7) | 46 (2.4) | 0.113 |
Table 2 Postoperative mortality, morbidity, and treatment modality among patients with anastomotic leakage after radical gastrectomy before (2009-2013) and after (2014-2016) implementation of the abdominal negative pressure lavage-drainage system n (%)
Postoperative condition | All patients (n = 83) | 2009-2013 (n = 37) | 2014-2016 (n = 46) | P-value |
Death | 7 (8.4) | 6 (16.2) | 1 (2.2) | 0.041 |
Time of occurrence of AL, d (mean) | 5.6 | 5.4 | 5.7 | 0.738 |
Other complication | ||||
Pneumonia | 41 (49.3) | 16 (43.2) | 25 (54.3) | 0.315 |
Abdominal bleeding | 8 (9.6) | 7 (18.9) | 1 (2.2) | 0.020 |
Pancreatic fistula | 3 (3.6) | 3 (8.1) | 0 (0) | 0.085 |
Chylous leak | 4 (4.8) | 3 (8.1) | 1 (2.2) | 0.319 |
Anastomotic bleeding | 2 (2.4) | 2 (5.4) | 0 (0) | 0.196 |
Wound infection | 4 (4.8) | 2 (5.4) | 2 (4.3) | > 0.999 |
ARF&RI | 2 (2.4) | 2 (5.4) | 0 (0) | 0.196 |
Cardiac event | 2 (2.4) | 1 (2.7) | 1 (2.2) | > 0.999 |
HF and hypohepatia | 2 (2.4) | 1 (2.7) | 1 (2.2) | > 0.999 |
Treatment | ||||
No invasive | 58 (69.9) | 18 (48.6) | 40 (87.0) | < 0.001 |
CT-guided puncture drainage | 16 (19.3) | 11 (29.7) | 5 (10.9) | 0.030 |
endoscopy | 3 (3.6) | 3 (8.1) | 0 (0) | 0.085 |
Reoperation | 6 (7.2) | 5 (13.5) | 1 (2.2) | 0.084 |
Length of stay, d (mean) | 30.2 | 31.6 | 28.4 | 0.458 |
Table 3 Risk factors predictive of anastomotic leakage after radical gastrectomy
Factor | Multivariate analysis results | |
OR (95%CI) | P-value | |
Age, yr | ||
< 65 | Reference | 0.006 |
≥ 65 | 1.886 (1.195-2.975) | |
Malnourished | ||
No | Reference | 0.005 |
Yes | 2.194 (1.267-3.797) | |
Comorbidities | ||
No | Reference | 0.171 |
Yes | 1.377 (0.871-2.178) | |
HB, g/dL | ||
≥ 90 | Reference | 0.221 |
< 90 | 1.441 (0.803-2.586) | |
Type of resection | ||
Subtotal gastrectomy | Reference | 0.069 |
Total gastrectomy | 1.534 (0.967-2.434) |
Table 4 Risk factors predictive of failure-to-rescue after anastomotic leakage with radical gastrectomy for gastric cancer
Factor | Univariate analysis | |
OR (95%CI) | P-value | |
ANPLDS therapy | ||
No | Reference | 0.040 |
Yes | 0.103 (0.012-0.898) | |
Age, yr | ||
< 65 | Reference | 0.532 |
≥ 65 | 0.607 (0.127-2.900) | |
Sex | ||
Female | Reference | 0.998 |
Male | / | |
BMI, kg/m2 | ||
< 25 | Reference | 0.773 |
≥ 25 | 1.289 (0.230-7.219) | |
History of abdominal surgery | ||
No | Reference | 0.849 |
Yes | 0.808 (0.090-7.286) | |
Tumor site | ||
Upper | Reference | 0.935 |
Middle | / | 0.998 |
Lower | 0.697 (0.106-4.578) | 0.707 |
≥ 2 areas | 1.394 (0.203-9.585) | 0.736 |
Malnourished | ||
No | Reference | 0.710 |
Yes | 1.388 (0.247-7.802) | |
Tumor size, cm | ||
≤ 5 | Reference | 0.700 |
> 5 | 1.361 (0.283-6.535) | |
AJCC-TNM stage, 8th edition | ||
I-II | Reference | 0.115 |
III | 5.692 (0.654-49.570) | |
Comorbidities | ||
No | Reference | 0.448 |
Yes | 1.833 (0.383-8.765) | |
HB, g/dL | ||
≥ 90 | Reference | 0.728 |
< 90 | 0.678 (0.076-6.063) | |
ASA | ||
I-II | Reference | 0.567 |
III-IV | 1.944 (0.200-18.920) | |
Operation method | ||
Open | Reference | 0.073 |
Laparoscopic | 0.226 (0.044-1.149) | |
Type of resection | ||
Subtotal gastrectomy | Reference | 0.763 |
Total gastrectomy | 1.300 (0.236-7.166) | |
Type of reconstruction | ||
Billroth I | Reference | 0.997 |
Billroth II | 0.817 (0.148-4.520) | 0.817 |
Roux-en-Y | / | > 0.999 |
Other | / | 0.999 |
Surgical duration, min (SD) | ||
> 180 | Reference | 0.138 |
≤ 180 | 3.629 (0.661-19.914) | |
Intraoperative blood loss, ml | ||
> 50 | Reference | 0.997 |
≤ 50 | / |
- Citation: Zheng ZF, Lu J, Zhang PY, Xu BB, Zheng CH, Li P, Xie JW, Wang JB, Lin JX, Chen QY, Huang CM. Novel abdominal negative pressure lavage-drainage system for anastomotic leakage after R0 resection for gastric cancer. World J Gastroenterol 2019; 25(2): 258-268
- URL: https://www.wjgnet.com/1007-9327/full/v25/i2/258.htm
- DOI: https://dx.doi.org/10.3748/wjg.v25.i2.258