Purpose
Postoperative anastomotic leakage (PAL) is a serious complication of gastric cancer surgery. Although perioperative management has made significant progress, anastomotic leakage (AL) cannot always be prevented. Intraoperative leak testing (IOLT) may reduce the incidence of PAL and other postoperative complications. The aim of this study is to assess the relationship between IOLT and postoperative surgical complications in gastric cancer surgery.
Materials and methods
In this meta-analysis, we searched the PubMed, Embase, and Cochrane Library databases for clinical trials to assess the application of IOLT in gastric cancer surgery. Studies comparing the postoperative outcomes of IOLT and non-intraoperative leak testing (NIOLT) were included. Quality assessment, heterogeneity, risk of bias, and the level-of-evidence of the inclusions were evaluated. PAL, anastomosis-related complications, 30-day mortality, and reoperation rates were compared between the IOLT and NIOLT group.
Results
Our literature search returned 975 results, from which 3 trials (929 total patients) were included in our meta-analysis. Statistical heterogeneity was low. The primary outcome was PAL. IOLT statistically reduced the risk of PAL [3.08% vs9.54%; risk ratios (RR) 0.336, 95% CI, 0.189–0.600, P = 0.000]. It was also found that IOLT can lower the incidence of other postoperative outcomes. Anastomosis-related complication rates [3.94% vs13.14%; risk ratios (RR) 0.323, 95% CI, 0.182–0.572, P = 0.000] were significantly higher in the NIOLT group than the IOLT group. Moreover, IOLT was associated with lower reoperation rates [2.36% vs9.14%; risk ratios (RR) 0.301, 95% CI, 0.145–0.621, P = 0.001].
Conclusion
Due to the lower incidence of PAL, anastomosis-related complications, and reoperation rates, IOLT is recommended in gastric cancer surgery.
Purpose
Postoperative aerosol therapy is a common clinical intervention after general anesthesia that is aimed at preventing postoperative pulmonary complications (PPCs). However, few studies have evaluated its effectiveness. We evaluated the effectiveness of aerosol therapy on the prevention and treatment of PPCs in gastric cancer patients.
Methods
This cross-sectional study (consecutive case series) was based on the surgical gastric cancer patient registry at West China Hospital. The included cases were retrospectively evaluated.
Between January 2016 and December 2018, 1087 patients with pathologically confirmed gastric adenocarcinoma, and who had been subjected to radical surgery were enrolled in this study. These patients were assigned into two groups, the prophylactic aerosol group and the non-prophylactic aerosol group. Risk factors and intervention measures for PPCs were compared.
Among the 1087 patients, a total of 235 patients with PPCs and who had not received prophylactic aerosol therapy were enrolled in the therapeutic aerosol therapy subgroup. We determined whether therapeutic aerosol therapy could improve perioperative outcomes for gastric cancer patients with PPCs.
Results
There were no differences in PPCs incidences between gastric cancer patients administered with prophylactic aerosol (37.5%) and those without prophylactic aerosol administration (39.4%) (p = 0.510). Univariate analysis revealed that prophylactic aerosol therapy was not a protective against PPCs after gastric cancer surgery (p = 0.510). Multivariate analysis showed that there was no correlation between prophylactic aerosol therapy and PPCs (p = 0.894).
Conclusions
Postoperative aerosol therapy was not effective in the prevention or control of PPCs in gastric cancer patients.
Background: Anastomotic leakage following a radical gastrectomy is a serious complication of gastric cancer and esophagogastric junction cancer. The benefit of intraoperative leak testing for the prevention of postoperative anastomotic leakage has been controversial. We introduce a new procedure, which combines the techniques of gastroscopy, air, and methylene blue (GAM) for intraoperative leakage testing. Our objective was to evaluate the efficacy and safety of the GAM procedure for intraoperative leak testing and to compare the surgical complications of gastric cancer patients who underwent gastrectomy with and without intraoperative leak testing using the GAM procedure.Materials and Methods: A total of 210 patients who underwent radical gastrectomy for gastric cancer were included. Patients were divided into 2 groups: the intraoperative leak testing group using the GAM procedure (IOLT), and the group for which no intraoperative leak testing was done (NIOLT). Clinical and pathologic characteristics, the incidence of postoperative anastomotic leakage, and other surgical complications were compared between the 2 groups.Results: There were 82 patients in the IOLT group and 82 patients in the NIOLT group after propensity score matching. In the IOLT group, 4 (4.9%) patients were found to have anastomotic discontinuity during the operation; we repaired these anastomotic discontinuities intraoperatively. The incidence of postoperative anastomotic leakage was higher in the NIOLT group compared with the IOLT group, 6 (7.3%) versus 0 (0%), respectively (P = 0.01). The average time of the GAM procedure was 4.99 ± 1.75 minutes. The surgical time was prolonged by 30 minutes in the IOLT group compared with the NIOLT group, 302.2 ± 79.9 versus 272.1 ± 85.2, respectively (P = 0.02). The length of hospital stay, 15.80 ± 4.55 versus 17.00 ± 6.20 (P = 0.16) was reduced in the IOLT group compared with the NIOLT group. The logistic regression model suggested that IOLT, sex, age, Eastern Cooperative Oncology Group, cT stage, tumor diameter, pT stage, pN stage, and Lauren classification were not risk factors for postoperative complication.
Conclusions:The GAM procedure of intraoperative leakage testing can effectively reduce the incidence of postoperative anastomotic leakage in gastric cancer patients undergoing gastrectomy.
scite is a Brooklyn-based organization that helps researchers better discover and understand research articles through Smart Citations–citations that display the context of the citation and describe whether the article provides supporting or contrasting evidence. scite is used by students and researchers from around the world and is funded in part by the National Science Foundation and the National Institute on Drug Abuse of the National Institutes of Health.