Ninety-day mortality after total gastrectomy for gastric cancer

Shannon, Adrienne B.; Straker, Richard J.; Fraker, Douglas L.; Roses, Robert E.; Miura, John T.; Karakousis, Giorgos C.

doi:10.1016/j.surg.2021.02.010

Cited by 15 publications

(15 citation statements)

References 44 publications

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“…In all models, age was consistently identified as the most important factor associated with 90DM. Previous observational studies have shown that chronological age should be considered as an individual risk factor, with more pronounced incremental risk after ages of 75 and 80 years 30,31. However, the magnitude of increased risk might be further modulated by associated comorbidities.…”

Section: Discussionmentioning

confidence: 99%

“…Previous observational studies have shown that chronological age should be considered as an individual risk factor, with more pronounced incremental risk after ages of 75 and 80 years. 30,31 However, the magnitude of increased risk might be further modulated by associated comorbidities. Hospital volume activity arises as the second contributing variable to the model.…”

Section: Discussionmentioning

confidence: 99%

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Machine Learning Risk Prediction Model of 90-day Mortality After Gastrectomy for Cancer

et al. 2022

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Objective: To develop and validate a risk prediction model of 90-day mortality (90DM) using machine learning in a large multicenter cohort of patients undergoing gastric cancer resection with curative intent. Background: The 90DM rate after gastrectomy for cancer is a quality of care indicator in surgical oncology. There is a lack of well-validated instruments for personalized prognosis of gastric cancer. Methods: Consecutive patients with gastric adenocarcinoma who underwent potentially curative gastrectomy between 2014 and 2021 registered in the Spanish EURECCA Esophagogastric Cancer Registry database were included. The 90DM for all causes was the study outcome. Preoperative clinical characteristics were tested in four 90DM predictive models: Cross Validated Elastic regularized logistic regression method (cv-Enet), boosting linear regression (glmboost), random forest, and an ensemble model. Performance was evaluated using the area under the curve by 10-fold cross-validation. Results: A total of 3182 and 260 patients from 39 institutions in 6 regions were included in the development and validation cohorts, respectively. The 90DM rate was 5.6% and 6.2%, respectively. The random forest model showed the best discrimination capacity with a validated area under the curve of 0.844 [95% confidence interval (CI): 0.841-0.848] as compared with cv-Enet (0.796, 95% CI: 0.784-0.808), glmboost (0.797, 95% CI: 0.785-0.809), and ensemble model (0.847, 95% CI: 0.836-0.858) in the development cohort. Similar discriminative capacity was observed in the validation cohort. Conclusions: A robust clinical model for predicting the risk of 90DM after surgery of gastric cancer was developed. Its use may aid patients and surgeons in making informed decisions.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Machine Learning Risk Prediction Model of 90-day Mortality After Gastrectomy for Cancer

et al. 2022

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“…Li et al (2019) declare the 90-day mortality rate to be higher by 70%, compared to that of the period of 30day (3.4% versus 2.0% respectively) [5]. Shannon et al (2021) report that 39.2% to 46.2% (in 2004 and 2015, respectively) of the deaths within 90 days after total gastrectomy for cancer occur beyond 30 days postoperative [13]. In our patients, postoperative 90day mortality rate was higher by 42% compared to that within 30 day in patients aged ≤70 years (17 vs 12 cases of death, respectively).…”

Section: Discussionmentioning

confidence: 94%

“…This result corresponds to the results of other studies, confirming that restoration of patients' performance status requires longer period than one month period following total gastrectomy. According to Shannon et al (2021), high rates of 90-day mortality after total gastrectomy suggest the need for improved out-of-hospital postoperative care beyond 30 days [13].…”

Section: Discussionmentioning

confidence: 99%

Postoperative Mortality Rates following Total Gastrectomy for Gastric Cancer: Experience of a Single Surgical Team

et al. 2022

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Objective: Total gastrectomy is a complex surgical procedure that is characterized by significant postoperative morbidity and mortality rates and the patients may continue to experience adverse events beyond the standard 30-day follow-up period after surgery. The aim of this study is to investigate postoperative complication and 30-day/90-day mortality rates following total gastrectomy in a cohort of patients and highlight the possible ways that can improve the short-term outcome of this surgical procedure. Material and Methods: 401 patients underwent total gastrectomy for gastric carcinoma by a single surgical team from January 2001 till December 2021. The patients stratified in 3 groups based on the time period when surgery was performed, hospital- and treatment-related objective factors: group I (61 patients); group II (163 patients) and group III (177 patients). Results: Esophagojejunal anastomotic leakage rate varied with periods and ranged from 1.1% to 3.3%, 1.7% in total. Differences were insignificant in complication and death rates between the patients aged ≤70 years and > 70 years (p>0.05). Postoperative death rate within 90 days was higher by 42% compared to that in standard 30-day follow-up period. Neaodjuvant chemotherapy was not found to be associated with an increased rate of 30-day postoperative mortality (p>0.05). Conclusion(s): Total gastrectomy for gastric cancer may be associated with minimal rates of esophagojejunal anastomotic leakage and mortality when performed by specialized and experienced high-volume surgeons. 90-day mortality rate after total gastrectomy is 42% higher compared to 30-day mortality that warrants more intense monitoring of the relevant patients within 3 months after surgery.

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“…A meta-analysis on esophagogastric anastomosis by Markar et al, as well as recent meta-analysis on esophago-jejunal anastomosis, confirmed these results [ 6 , 50 ]. Two large-cohort studies performed using the National Cancer Databases reported in-hospital mortality (2.2%), 30-day mortality (0.9–4.7%), and 90-day mortality (9.1%) [ 37 , 51 ]. In our study, there was only 1 death during the first 90 days after surgery, due to the surgical complications and subsequent sepsis during hospitalization (90-day mortality was 1.39%), which is acceptable percentage, similar to other high-volume centers [ 52 ].…”

Section: Discussionmentioning

confidence: 99%

Comparison of Postoperative Outcomes of Hand-Sewn Versus Stapled Esophago-jejunal Anastomosis During Total Gastrectomy for Gastric Cancer in 72 Patients: A Retrospective, Single-Center Study in Poland

et al. 2023

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Background:Mechanical stapling is a commonly used alternative to hand-sewn technique for esophago-jejunal anastomosis in total gastrectomy (TG). Some studies report reduction in postoperative complications in the stapler group. This retrospective study aimed to compare short-and long-term surgical outcomes between the groups with stapled and hand-sewn esophago-jejunal anastomosis (EJA) during open TG for gastric cancer. Material/Methods:The study included 72 adult patients with gastric cancer who underwent TG in the Department of Digestive Tract Surgery in Katowice between May 2018 and December 2021. The patients were divided into 2 groups according to the technique of EJA: stapled (44 cases) or hand-sewn (28 cases). We compared the groups in terms of the duration of the surgery, length of hospital stay, and occurrence of complications (focusing on anastomotic leakage, stricture and abdominal abscess). Results:There were no significant differences in duration of the surgery (P=0.6), blood loss (P=0.7), or length of postoperative hospital stay (P=0.2) among the groups. Early postoperative complications rates were 9.1% (4/44) in the stapler group and 17.9% (5/28) in the hand-sewn group (P=0.27). The most frequent complication was anastomotic leakage, with 2 cases in each group (P=0.76). The mean follow-up time was 1.8±0.9 (0.3-3.6) years. During this period the anastomotic stricture occurred in 7 (15.9%) cases with stapled anastomosis and in 5 (17.9%) cases with hand-sewn anastomosis (P=0.52). Conclusions:In this study there were no significant differences in mortality, morbidity, and surgery duration between stapled and hand-sewn esophago-jejunal anastomosis in total gastrectomy.

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Ninety-day mortality after total gastrectomy for gastric cancer

Cited by 15 publications

References 44 publications

Machine Learning Risk Prediction Model of 90-day Mortality After Gastrectomy for Cancer

Machine Learning Risk Prediction Model of 90-day Mortality After Gastrectomy for Cancer

Postoperative Mortality Rates following Total Gastrectomy for Gastric Cancer: Experience of a Single Surgical Team

Comparison of Postoperative Outcomes of Hand-Sewn Versus Stapled Esophago-jejunal Anastomosis During Total Gastrectomy for Gastric Cancer in 72 Patients: A Retrospective, Single-Center Study in Poland

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