Risk factors and post-operative complications after gastrectomy for cancer
Authors:
T. Jínek 1; L. Adamčík 1; R. Vrba 2; M. Duda 1,3; M. Škrovina 1,2
Authors place of work:
Chirurgické oddělení Nemocnice Nový Jičín, a. s., Centrum vysoce specializované onkologické péče pro dospělé Nový Jičín
1; I. chirurgická klinika Lékařské fakulty Univerzity Palackého Olomouc
2; II. chirurgická klinika Lékařské fakulty Univerzity Palackého Olomouc
3
Published in the journal:
Rozhl. Chir., 2018, roč. 97, č. 8, s. 384-393.
Category:
Original articles
Summary
Introduction:
Gastric resections due to carcinoma belong to the most demanding procedures in visceral surgery. This is due to the requirements for the extent of resection and lymphadenectomy, coupled with the need for functional reconstruction of the digestive tract. The procedure is associated with 18−46% morbidity, which delays administration of adjuvant therapy and worsens oncological results. Identification of risk factors for potential complications may play an important role in the indication and perioperative care. The aim of our study is to (i) evaluate the morbidity a mortality of a patient group with post-gastrectomy complications and to (ii) identify associated risk factors.
Method:
This retrospective analysis comprises patients treated in 2005−2016. Gastric resection was performed in 266 adenocarcinoma patients, 172 men and 94 women (median age 66 years). Early post-operative complications following gastrectomy were observed within 60 days. Complications and their severity were evaluated according to the extended form of the Accordion Severity Grading System. Selected demographic risk factors, operative factors and malignancy-related factors were analyzed. Multivariate regression (orthogonal projections to latent structure) was used for statistical processing.
Results:
Overall morbidity and mortality was 34.6% and 3.4%. Serious complications occurred in 51 operated patients (19.2%). 24 patients had two or three complications (9%). The most common grades of severity were grade 2 in 31 patients (11.7%) and grade 4 in 20 patients (10.9%). The duration of hospital stay correlated with the severity of the complication. Most common surgical complications were: intra-abdominal abscess (16.4%, 17 cases), wound complications (5.3%, 14 cases), pancreatitis (4.9%, 13 cases), anastomotic leakage (3.4%, 9 cases), postoperative ileus (3.4%, 9 cases). Respiratory and cardiac complications were the most common non-surgical complications (8.6%, 23 cases and 3.8%, 20 cases, respectively). In the derived statistical model, BMI, the presence of more comorbidities, lesser surgical experience, the length of hospital stay and hospitalization at ICU were identified as risk factors associated with the grade of complication, morbidity, presence of serious complication and multiple complications.
Conclusion:
Gastrectomy plays a fundamental role in the curative treatment of gastric carcinoma; it is, however, associated with substantial morbidity and mortality. The best management of complications is their prevention. Preoperatively, the greatest attention should be paid to patients with several comorbidities and higher BMI. Resections should be performed by experienced surgeons. During resection, consideration should be given to the extent of resection and lymphadenectomy. In the postoperative period, the length of hospital stay, especially at ICU, should be reduced to minimum. Analyses of these risk factors may decrease the incidence of complications.
Key words:
gastric cancer – gastrectomy − risk factors − complications
Zdroje
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