Risk Factors for Severe Postoperative Complications After Gastrectomy for Gastric and Esophagogastric Junction Cancers

Abstract

Background: Gastrectomy is the main treatment for gastric and Siewert type II-III esophagogastric junction (EGJ) cancer. This surgery is associated with significant morbidity. Total morbidity rates vary across different studies and few have evaluated postoperative morbidity according to complication severity. Aim: To identify the predictors of severe postoperative morbidity. Methods: This was a retrospective cohort study from a prospective database. We included patients treated with gastrectomy for gastric or EGJ cancers between January 2012 and December 2016 at a single center. Severe morbidity was defined as Clavien-Dindo score ≥3. A multivariate analysis was performed to identify predictors of severe morbidity. Results: Two hundred and eighty-nine gastrectomies were performed (67% males, median age: 65 years). Tumor location was EGJ in 14%, upper third of the stomach in 30%, middle third in 26%, and lower third in 28%. In 196 (67%), a total gastrectomy was performed with a D2 lymph node dissection in 85%. Two hundred and eleven patients (79%) underwent an open gastrectomy. T status was T1 in 23% and T3/T4 in 68%. Postoperative mortality was 2.4% and morbidity rate was 41%. Severe morbidity was 11% and was mainly represented by esophagojejunostomy leak (2.4%), duodenal stump leak (2.1%), and respiratory complications (2%). On multivariate analysis, EGJ location and T3/T4 tumors were associated with a higher rate of severe postoperative morbidity. Conclusion: Severe postoperative morbidity after gastrectomy was 11%. Esophagogastric junction tumor location and T3/T4 status are risk factors for severe postoperative morbidity.

Lessons Learned Analyzing Complications After Laparoscopic Total Gastrectomy for Gastric Cancer

“…Laparoscopic surgery has proved to be safe and effective with less pain, less bleeding and a shorter recovery time. The randomized studies during the last decade have shown excellent results in terms of complication rates, which are very similar to open surgery 1,2,20,21,28,29 .…”

“…; 3) total or partial major omentectomy; 4) management of the duodenal stump; 5) type of esophagojejunal anastomosis; 6) jejunojejunostomy; 7) extraction of the stomach and omentum. These are the most controversial points or situations that are eventually associated with intraoperative difficulties or postoperative complications 5 , 21 , 22 , 27 .…”

Robotic Gastrectomy: Technique Standardization

“…Laparoscopic gastrectomy has an extensive learning curve 6 and many differences when compared to the open approach: critical view, instrumental manipulation, presentation, ergonomics, etc. Robotic access is considered by some as an enhanced laparoscopy 11 , and those with experience in minimally invasive gastrectomy show quick adaptation 10,12 . However, the access has its own particularities, with increased complications in the beginning and massive learning curve, despite laparoscopic expertise 8 .…”

Ii Brazilian Consensus on Gastric Cancer by the Brazilian Gastric Cancer Association

“…The incidence of gastric cancer (GC) has decreased around the world. Once the second most common type of cancer, currently CG is the fifth, after lung, breast, prostate and colorectal 6,10,15 . Its incidence has dropped in the last 50 years due to the improvement in basic sanitation conditions, the use of refrigerators and consumption improvement of fresh fruits and vegetables and less salt intake, which was then widely used to preserve food.…”