Morbidity and mortality after total gastrectomy for gastric malignancy using the American College of Surgeons National Surgical Quality Improvement Program database

Bartlett, Edmund K.; Roses, Robert E.; Kelz, Rachel R.; Drebin, Jeffrey A.; Fraker, Douglas L.; Karakousis, Giorgos C.

doi:10.1016/j.surg.2014.03.022

Cited by 109 publications

(80 citation statements)

References 23 publications

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“…Numerous studies have demonstrated the correlation between high surgical volume and lower mortality (13, 24–26). This phenomenon is reflected by comparing our mortality (2.9%) to the other studies in the group: it is lower than the 4.7% (11) or 5.4% (8) reported in the NSQIP series’, or the 3.5% reported by Pacelli (10). Yet, our esophageal anastomotic leak rate is higher.…”

Section: Discussioncontrasting

confidence: 47%

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Morbidity after Total Gastrectomy: Analysis of 238 Patients

Selby

Vertosick

Sjoberg

et al. 2015

Journal of the American College of Surgeons

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Background Surgical quality improvement requires well-defined benchmarks and accurate reporting of postoperative adverse events, which have not been well defined for total gastrectomy. Study Design Detailed post-operative outcomes on 238 patients who underwent curative intent total gastrectomy from 2003 – 2012 were reviewed by a dedicated surgeon chart reviewer to establish the 90-day patterns of adverse events. Results Of the 238 patients with stage I – III gastric adenocarcinoma who underwent curative intent total gastrectomy, the median age was 66, and 68% were male. Median body mass index was 28, and 68% of patients had at least one medical comorbidity. Forty three percent of our patients received neoadjuvant chemotherapy, and 34% received post-operative adjuvant chemotherapy. Over the 90 day study period, 30-day mortality was 2.5% (6/238), and 90-day mortality was 2.9% (7/238). At least one post-operative adverse event was documented in 62% of patients, with 28% of patients experiencing a major adverse event requiring invasive intervention. The readmission rate was 20%. Anemia was the most common adverse event (20%), followed by wound complications (18%). The most common major adverse event was esophageal anastomotic leak, which required invasive intervention in 10% of patients. Conclusion This analysis has defined comprehensive 90-day patterns in post-operative adverse events following curative intent total gastrectomy in a Western population. This benchmark allows surgeons to measure, compare, and improve outcomes and informed consent for this surgical procedure.

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Section: Discussioncontrasting

confidence: 47%

“…Two recent studies have examined the NSQIP total gastrectomy experience (8, 11). Examining 999 total gastrectomies from 2005 – 2010, Papenfuss et al found a median length of stay of 13 days, a “serious morbidity” rate of 29.3%, and a 30 day mortality rate of 5.4%.…”

Section: Discussionmentioning

confidence: 99%

Morbidity after Total Gastrectomy: Analysis of 238 Patients

Selby

Vertosick

Sjoberg

et al. 2015

Journal of the American College of Surgeons

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“…The incidence of complications after upfront surgery for gastroesophageal cancer is frequent, ranging from 20–40%, depending on the population of patients studied and the assiduousness with which complications are tallied . Our finding of a 42% complication rate and a 0% mortality rate in our patients treated with neoadjuvant therapy followed by surgery is certainly consistent with prior reports of morbidity and mortality after gastric cancer surgery alone.…”

Section: Discussionsupporting

confidence: 89%

The impact of neoadjuvant therapy for gastroesophageal adenocarcinoma on postoperative morbidity and mortality

Fuentes

Ahmad

Hong

et al. 2016

Journal of Surgical Oncology

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“…13 It is higher than that observed in an Asian study that established a risk model for morbimortality in total gastrectomy attending 20,011 patients, in which overall morbidity was 26.2 %. 14 However, the incidence of some important specific complications was similar.…”

Section: Discussionmentioning

confidence: 71%