Insufficiency risk of esophagojejunal anastomosis after total abdominal gastrectomy for gastric carcinoma

Meyer, L.; Meyer, Frank; Dralle, Henning; Ernst, Moritz; Lippert, H.; Gastinger, I.

doi:10.1007/s00423-005-0575-2

Cited by 49 publications

(32 citation statements)

References 18 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…12.2002 in 80 chirurgischen Kliniken jeglichen Versorgungsprofils (Grund-und Regelversorgung bis zu Universitätskliniken) stationär aufgenommen wurden. Eine detaillierte Darstellung der Methodik, des Studiendesigns und von Teilergebnissen der Gesamtstudie wurden bereits publiziert [1,2,3].…”

Section: Methodeunclassified

Fortgeschrittenes Magenkarzinom

Gastinger

Ebeling

Meyer

et al. 2011

Chirurg

Self Cite

View full text Add to dashboard Cite

Radical tumor resection with palliative intentions (if possible from a technical point of view) resulted in a prolongation of the median survival time of 3 months with an acceptable postoperative morbidity and mortality compared with non-resection procedures. According to the results of individual analysis of each tumor resection intervention, palliative gastrectomy showed a significant prolongation of survival time of 5 months compared with more limited subtotal resection (6 versus 11 months).

show abstract

Section: Methodeunclassified

Fortgeschrittenes Magenkarzinom

Gastinger

Ebeling

Meyer

et al. 2011

Chirurg

Self Cite

View full text Add to dashboard Cite

show abstract

“…Proportions of patients in whom an R0 resection was achieved (blue) and patients deemed unresectable at preoperative diagnostics (green) or at laparotomy (red) among our patients, the GGCS study cohort and the EGGCS study cohort tomotic leaks in our study is at least partly due to the difference in tumor characteristics between the EGGCS cohort and our patients (higher proportion of locally advanced and proximally located tumors in our study). In a multivariate analysis of the EGGCS data tumor stenosis and dysphagia (both of which are frequently associated with locally advanced tumors) were demonstrated to be independently associated with a higher risk of anastomotic leakage after gastrectomy (31). D2 lymphadenectomy has gained widespread acceptance as standard of care in gastric cancer surgery in Germany (22).…”

Section: Discussionmentioning

confidence: 99%

Epidemiology, Surgical Management and Early Postoperative Outcome in a Cohort of Gastric Cancer Patients of a Tertiary Referral Center in Relation to Multi-Center Quality Assurance Studies

Garlipp

Schwalenberg

Adolf

et al. 2011

Polish Journal of Surgery

View full text Add to dashboard Cite

the aim of the study was to analyze epidemiologic parameters, treatment-related data and prognostic factors in the management of gastric cancer patients of a university surgical center under conditions of routine clinical care before the onset of the era of multimodal therapies. By analyzing our data in relation with multi-center quality assurance trials [German Gastric Cancer Study -GGCS (1992) and East German Gastric Cancer Study -EGGCS (2004)] we aimed at providing an instrument of internal quality control at our institution as well as a base for comparison with future analyses taking into account the implementation of evolving (multimodal) therapies and their influence on treatment results. material and methods. Retrospective analysis of prospectively gathered data of gastric cancer patients treated at a single institution during a defined 10-year time period with multivariate analysis of risk factors for early postoperative outcome. results. From 04/01/1993 through 03/31/2003, a total of 328 gastric cancer patients were treated. In comparison with the EGGCS cohort there was a larger proportion of patients with locally advanced and proximally located tumors. 272 patients (82.9%) underwent surgery with curative intent; in 88.4% of these an R0 resection was achieved (EGGCS/GGCS: 82.5%/71.5%). 68.2% of patients underwent preoperative endoluminal ultrasound (EUS) (EGGCS: 27.4%); the proportion of patients undergoing EUS increased over the study period. Diagnostic accuracy of EUS for T stage was 50.6% (EGGCS: 42.6%). 77.2% of operated patients with curative intent underwent gastrectomy (EGGCS/GGCS: 79.8%/71.1%). Anastomotic leaks at the esophagojejunostomy occurred slightly more frequently (8.8%) than in the EGGCS (5.9%) and GGCS (7.2%); however, postoperative morbidity (36.1%) and early postoperative mortality (5.3%) were not increased compared to the multi-center quality assurance study results (EGGCS morbidity, 45%); EGGCS/GGCS mortality, 8%/8.9%). D2 lymphadenectomy was performed in 72.6% of cases (EGGCS: 70.9%). Multivariate analysis revealed splenectomy as an independent risk factor for postoperative morbidity and ASA status 3 or 4 as an independent risk factor for early postoperative mortality. The rate of splenectomies performed during gastric cancer surgery decreased substantially during the study period. conclusions. Preoperative diagnostics were able to accurately predict resectability in almost 90% of patients which is substantially more than the corresponding results of both the EGGCS and the GGCS. In the future, more wide-spread use of EUS will play an increasing role as stage-dependent differentiation of therapeutic concepts gains acceptance. However, diagnostic accuracy of EUS needs to be improved. Our early postoperative outcome data demonstrate that the quality standard of gastric cancer care established by the EGGCS is being fulfilled at our institution in spite of distinct characteristics placing our patients at higher surgical risk. Besides being a valuable instrument of internal quality con...

show abstract

“…Im Vergleich zur Ösophagogastrosto-mie ist die Insuffizienz der Ösophagojeju-nostomie nach Gastrektomie in erfahrenen Zentren in der Regel weniger häufig. Allgemein wurden Insuffizienzraten von 0-26% berichtet, jedoch erzielen spezialisierte Zentren Raten von 5-8% oder weniger [31,36,51,52].…”

Section: Nahtinsuffizienzen Nach Magenresektionunclassified

Diagnostik und Definition der Nahtinsuffizienz aus chirurgischer Sicht

Welsch

Frankenberg

Schmidt

et al. 2010

Chirurg

View full text Add to dashboard Cite

The leak rates of different gastrointestinal anastomoses vary considerably but despite this there are common and general concepts for diagnosis and management. Early diagnosis and timely consistent therapy must guide management to prevent harm to the patients. Diagnosis of anastomotic leaks is coupled to clinical signs of the patients and should be initiated promptly. Dependent on the localization of the leak, computed tomography with administration of oral or rectal contrast dye and endoscopy are of high diagnostic value. Both procedures guarantee the option of drainage or stenting through interventional drains or stent placement. Only the implementation of uniform definitions of anastomotic leaks enables surgeons to compare and to improve surgical treatment. Over recent years consensus definitions of postoperative complications including bile leak, pancreatic fistula and colorectal leak have been formulated. These definitions are based on a 3-fold increase of bilirubin (bile leak) or amylase levels (pancreatic fistula) in abdominal drainage fluid compared to serum levels or on an intestinal wall defect with communication of the intraluminal and extraluminal compartments (colorectal anastomosis). The definitions each describe three severity grades A-C. A change of clinical management is required in grade B whereas grade C usually requires a re-operation. Comparable consensus definitions for anastomotic leaks following esophagogastrostomy or esophagojejunostomy or following small bowel anastomosis have not been established. The authors strongly recommend implementation of the presented consensus definitions into clinical and academic daily practice.

show abstract

Insufficiency risk of esophagojejunal anastomosis after total abdominal gastrectomy for gastric carcinoma

Cited by 49 publications

References 18 publications

Fortgeschrittenes Magenkarzinom

Fortgeschrittenes Magenkarzinom

Epidemiology, Surgical Management and Early Postoperative Outcome in a Cohort of Gastric Cancer Patients of a Tertiary Referral Center in Relation to Multi-Center Quality Assurance Studies

Diagnostik und Definition der Nahtinsuffizienz aus chirurgischer Sicht

Contact Info

Product

Resources

About