Clinical outcome of transarterial embolization for postgastrectomy arterial bleeding

PurposeUnplanned reoperation (URO) after radical gastrectomy for gastric cancer (GC) mostly results from serious postoperative complications. At present, there is still controversy over the predictive factors for URO. Our goal was to identify the risk factors for URO and to investigate its potential impact on long-term survival.Patients and methodsWe included 2,852 GC patients who underwent a gastrectomy. Multivariate logistic regression analyses were performed to determine the risk factors for URO. Patients were randomly selected from the non-URO group by 1:4 propensity score matching with multiple parameters with patients from the URO group. The survival disparity of 34 URO patients and 136 non-URO patients was examined using the Kaplan–Meier method and the multivariate Cox proportional hazard model.ResultsThe incidence of URO was 1.4% (39/2, 852). The primary cause of URO was intra-abdominal bleeding (53.9%, 21/39). Multivariate logistic regression analyses revealed that male gender (OR = 4.630, 95% CI = 1.412–15.152, P = 0.011), diabetes (OR = 4.189, 95% CI = 1.705–10.290, P = 0.002), and preoperative hypoproteinemia (OR = 2.305, 95% CI = 1.079–4.923, P = 0.031) were independent risk factors for URO. With regard to early surgical outcomes, patients undergoing URO had a longer hospital stay (P < 0.001), higher incidence of postoperative complications (P < 0.001), and greater mortality (P < 0.001) compared with the non-URO group. No significant correlation was found between URO and cancer-specific survival in univariate (P = 0.275) and multivariate (P = 0.090) survival analyses.ConclusionMale gender, diabetes, and preoperative hypoproteinemia were suggested as independent risk factors for URO. URO was associated with longer hospital stay and increased perioperative mortality, but might not be correlated with long-term mortality.

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“… 26 , 27 In case radiological intervention fails, immediate shift to surgical treatment is compulsory. 28 , 29 …”

Section: Discussionmentioning

confidence: 99%

Unplanned reoperation after radical gastrectomy for gastric cancer: causes, risk factors, and long-term prognostic influence

Zuo

Cai

Chen

et al. 2018

TCRM

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“…In a patient with partial or total gastrectomy, the left gastric artery and gastroduodenal arteries may be ligated leaving the short gastric arteries from splenic artery as sole supply to the gastric remnant (if present). 11 In a gastric pull-up, the right gastroepiploic artery originating from the gastroduodenal artery is the only blood supply to the pull-up and usually cannot be safely embolized. 12 In a life-threatening situation, it may be sometimes advisable to do whatever is necessary to stop hemorrhage.…”

Section: How Can I Mess This Up?mentioning

confidence: 99%

Gastrointestinal Bleeding on Call: Questions and Answers and One Person's Opinions

Funaki

2020

Semin intervent Radiol

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Gastrointestinal (GI) bleeding represents one of the more morbid forms of hemorrhage that interventional radiologists deal with on an on-call basis. Bleeding from the GI tract takes many forms and has many etiologies. While venous bleeds from varices are often treated emergently with placement of a transjugular intrahepatic portosystemic shunt, arterial hemorrhages are treated most effectively with embolization procedures. Embolization must be performed in specific ways, however, in an effort to decrease the risk of bowel ischemia; this also requires choosing the right patients in whom to perform embolization procedures. This article will provide a discussion on when to perform embolization and how, what to do with specific patient populations such as those with coagulopathy, and which patients should be considered for emergent treatment versus those that can be postponed.

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“…2). 10,11 If TAE is inevitable, additional resection of the gastric remnant and/or spleen may be required to avoid infarction of the organ and following sepsis. 11,12 The placement of a stent graft in the splenic artery would not only treat bleeding but also salvage the spleen and/or the gastric remnant.…”

Section: Treatmentmentioning

confidence: 99%

Interventional radiology for post-gastrectomy complications

Park

Shin

2019

Int J Gastrointest Interv

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Complications following gastrectomy can be life-threatening, but, they are commonly managed by interventional radiology. This review describes possible complications after gastrectomy by dividing them into vascular and non-vascular categories. Vascular complications are mostly arterial bleeding and varix bleeding. Non-vascular complications comprise abscess, fistula, benign anastomotic stricture, and malignant obstruction, e.g. afferent loop syndrome, by tumor recurrence. Interventional managements for treatment of post-gastrectomy complications are safe, effective, and less invasive compared with surgery.

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Clinical outcome of transarterial embolization for postgastrectomy arterial bleeding

Cited by 11 publications

References 21 publications

Unplanned reoperation after radical gastrectomy for gastric cancer: causes, risk factors, and long-term prognostic influence

Unplanned reoperation after radical gastrectomy for gastric cancer: causes, risk factors, and long-term prognostic influence

Gastrointestinal Bleeding on Call: Questions and Answers and One Person's Opinions

Interventional radiology for post-gastrectomy complications

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