Risk factors and laboratory markers used to predict
leakage in esophagojejunal anastomotic leakage after
total gastrectomy

değer, kamuran cumhur; aday, ulas; Çiyiltepe, Hüseyin; Çetin, Durmuş Ali; Duman, Mustafa

Risk factors and laboratory markers used to predict leakage in esophagojejunal anastomotic leakage after total gastrectomy

Durmuş Ali ÇETİN, (Şanlıurfa Eğitim ve Araştırma Hastanesi, Gastroenteroloji Cerrahi Kliniği, Şanlıurfa, Türkiye)

Hüseyin CİGİLTEPE, (Fatih Sultan Mehmet Eğitim ve Araştırma Hastanesi, Gastroentereloji Cerrahi Kliniği, İstanbul, Türkiye)

Ulas ADAY, (Elazığ Eğitim ve Araştırma Hastanesi, Gastroenteroloji Cerrahi Kliniği, Elazığ, Türkiye)

Kamuran Cumhur DEGER, (Kartal Koşuyolu Yüksek İhtisas Eğitim ve Araştırma Hastanesi, Gastroenteroloji Cerrahi Kliniği, İstanbul Türkiye)

Mustafa DUMAN (Kartal Koşuyolu Yüksek İhtisas Eğitim ve Araştırma Hastanesi, Gastroenteroloji Cerrahi Kliniği, İstanbul Türkiye)

Turkish Journal of Surgery

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Yıl: 2019 Cilt: 35 Sayı: 1 Sayfa Aralığı: 6 - 12 Metin Dili: İngilizce İndeks Tarihi: 10-07-2022

Risk factors and laboratory markers used to predict leakage in esophagojejunal anastomotic leakage after total gastrectomy

Öz:

Objective: Esophagojejunal anastomotic leakages, which occur in the reconstruction procedures performed after total or proximal gastrectomy, still account for one of the most significant causes of morbidity and mortality in spite of the developments seen in perioperative management and surgical techniques in gastric cancer surgery. The aim of the present study was to ascertain the risk factors for Esophagojejunal anastomotic leakages. Material and Methods: A total of 80 patients with gastric cancer, who had total gastrectomy +D2 lymph node dissection and Esophagojejunal anastomotic between January 2013 and December 2016, were retrospectively evaluated. Patients who did not have anastomotic leakages during their clinical follow-ups were allocated to Group 1, whereas those who had anastomotic leakages were allocated to Group 2. Results: A total of 58 (72.5%) out of 80 patients were males, whereas 22 (27.5%) were females. Mean age of the patients was 61.2 ± 11.2 years. There were no demographic differences between the groups. Postoperative recurrent fever (p= 0.001), C-reactive protein values on postoperative days 3 and 5 (p= 0.01), and neutrophil-to-lymphocyte ratio on postoperative day 5 (p= 0.022) were found to be statistically significant with regard to Esophagojejunal anastomotic leakages and other postoperative complications. The duration of operation (p= 0.032) and combined organ resection (p= 0.008) were ascertained as risk factors for Esophagojejunal anastomotic leakages. Conclusion: Surgeons should be careful about Esophagojejunal anastomotic leakages which are significant postoperative complications seen especially in cases where the duration of operation is prolonged, and additional organ resections are performed. Recurrent fever, high C-reactive protein levels, and neutrophil-to-lymphocyte ratio may serve as warnings for complications in postoperative follow-ups.

Anahtar Kelime:

Total gastrektomi sonrası özefagojejunal anastomoz kaçağında risk faktörleri

Öz:

Giriş ve Amaç: Mide kanseri cerrahisinde perioperatif yönetim ve cerrahi teknikteki gelişmelere rağmen, total veya proksimal gastrektomi sonrası yapılan rekonstruksiyonda özefagojejunal anastomoz (ÖJA) kaçağı halen önemli bir morbidite ve mortalite nedenidir. Bu çalışmada, ÖJA kaçağı açısından risk faktörlerinin belirlenmesi amaçlanmıştır. Gereç ve Yöntem: Ocak 2013 ile Aralık 2016 tarihleri arasında total gastrektomi +D2 lenf nodu diseksiyonu ve ÖJA yapılan 80 mide kanserli hasta retrospektif olarak değerlendirildi. Klinik takipleri sırasında anastomoz kaçağı gelişmeyen hastalar grup 1’i, anastomoz kaçağı gelişenler ise grup 2’yi oluşturdu. Bulgular: Çalışmaya dahil edilen 80 hastanın 58 (72.5%)’i erkek, 22 (27.5%)’si kadın olup yaş ortalaması 61.2 ± 11.2 idi. Gruplar arasında demografik özellikler açısından farklılık saptanmadı. Postoperatif tekrarlayıcı ateş (p= 0.001), postoperatif 3. ve 5. gün C-reaktif protein (CRP) değerleri (p= 0.01) ve postoperatif 5. gün nötrofil/lenfosit oranı (NLO) (p= 0.022) ÖJA kaçağı ve diğer postoperatif komplikasyonlar açısından istatistiksel olarak anlamlı saptandı. Operasyon süresi (p= 0.032) ve kombine organ rezeksiyonu (p= 0.008) ÖJA kaçak açısından risk faktörleri olarak belirlendi. Sonuç: Cerrahlar özellikle operasyon süresinin uzadığı ve ek organ rezeksiyonunun yapıldığı durumlarda, ameliyat sonrası önemli bir komplikasyon olan ÖJA kaçağı açısından dikkatli olmalıdırlar. Postoperatif dönemdeki takiplerde tekrarlayan ateş, yüksek CRP değeri ve NLO komplikasyonlar açısından uyarıcı olabilir.

Anahtar Kelime:

Belge Türü: Makale Makale Türü: Araştırma Makalesi Erişim Türü: Erişime Açık

1. Ichikawa D, Kurioka H, Yamaguchi T, Koike H, Okamoto K, Otsuji E, et al. Postoperative complications following gastrectomy for gastric cancer during the last decade. Hepatogastroenterology 2004; 51 :613-7.
2. Isozaki H, Okajima K, Ichinona T, Hara H, Fujii K, Nomura E. Risk factors of esophagojejunal anastomotic leakage after total gastrectomy for gastric cancer. Hepatogastroenterology 1997; 44: 1509-12.
3. Nomura S, Sasako M, Katai H, Sano T, Maruyama K. Decreasing complication rates with stapled esophagojejunostomy following a learning curve. Gastric Cancer 2000; 3: 97-101.
4. Park DJ, Lee HJ, Kim HH, Yang HK, Lee KU, Choe KJ. Predictors of Operative morbidity and mortality in gastric cancer surgery. Br J Surg 2005; 92: 1099-102.
5. Sierzega M, Kolodziejczyk P, Kulig J. Impact of anastomotic leakage on long-term survival after total gastrectomy for carcinoma of the stomach. Br J Surg 2010; 97: 1035-42.
6. Hyodo M, Hosoya Y, Hirashima Y, Haruta H, Kurashina K, Saito S, et al. Minimum leakage rate (0.5 %) of stapled esophagojejunostomy with sacrifice of a small part of the jejunum after total gastrectomy in 390 consecutive patients. Dig Surg 2007; 24: 169-72.
7. Lang H, Piso P, Stukenborg C, Raab R, Jähne J. Management and results of proximal anastomotic leaks in a series of 1,114 total gastrectomies for gastric carcinoma. Eur J Surg Oncol 2000; 26: 168-71.
8. Deguchi Y, Fukagawa T, Morita S, Ohashi M, Saka M, Katai H. Identification of Risk Factors for Esophagojejunal Anastomotic Leakage after Gastric Surgery. World J Surg 2012; 36: 1617-22.
9. Meyer L, Meyer F, Dralle H, Ernst M, Lippert H, Gastinger I. Insufficiency risk of esophagojejunal anastomosis after total abdominal gastrectomy for gastric carcinoma. Langenbecks Arch Surg 2005; 390: 510-6.
10. Bruce J, Krukowski ZH, Al-Khairy G, Russell EM, Park KGM. Systematic review of the definition and measurement of anastomotic leak after gastrointestinal surgery. Br J Surg 2001; 88: 1157-68.
11. Migita K, Takayama T, Matsumoto S, Wakatsuki K, Enomoto K, Tanaka T, et al. Risk factors for esophagojejunal anastomotic leakage after elective gastrectomy for gastric cancer. J Gastrointest Surg 2012; 16: 1659-65.
12. Crapo MD, Hankison JL, Irvin C, Mancityre NL, Voter KZ, Wise RA. American Thoracic Society: Standardization of spirometry: 1994 update. Am J Respir Crit Care Med 1995; 152: 1107-36.
13. Dindo D, Demartines N, Clavien PA. Classification of surgical complications: a new proposal with evaluation in a cohort of 6336 patients and results of a survey. Ann Surg 2004; 240: 205-13.
14. Edge SB, Compton CC. The American Joint Committee on Cancer: The 7th edition of the AJCC cancer staging manual and the future of TNM. Ann Surg Oncol 2010; 17: 1471-4.
15. Watanabe M, Miyata H, Gotoh M, Baba H, Kimura W, Tomita N, et al. Total gastrectomy risk model: data from 20,011 Japanese patients in a nationwide internet-based database. Ann Surg 2014; 260: 1034-9.
16. Kodera Y, Sasako M, Yamamoto S, Sano T, Nashimoto A, Kurita A. Identification of risk factors for the development of complications following extended and super-extended lymphadenectomies for gastric cancer. Br J Surg 2005; 92: 1103-9.
17. Lo CH, Chen JH, Wu CW, Lo SS, Hsieh MC, Lui WY. Risk factors and management of intra-abdominal infection after extended radical gastrectomy. Am J Surg 2008; 196: 741-5.
18. Yasuda K, Shiraishi N, Adachi Y, Inomata M, Sato K, Kitano S. Risk factors for complications following resection of large gastric cancer. Br J Surg 2001; 88: 873-7.
19. Vural V, Saylam B, Çomçalı B, Düzgün AP, Özer MV, Coşkun F. D1 versus D2 dissection in stomach carcinoma: Evaluation of postoperative mortality and complications. Turk J Surg 2013; 29: 1-6.
20. Bonenkamp JJ, Songun I, Herman J, Sasako M, Welvaart K, Plukker JT, et al. Randomised comparison of morbidity after D1 and D2 dissection for gastric cancer in 996 Dutch patients. Lancet 1995; 345: 745-8.
21. Bonenkamp JJ, Hermans J, Sasako M, Welvaart K, Songun I, Meyer S, et al. Extended lymph-node dissection for gastric cancer. N Engl J Med 1999; 340: 908-14.
22. Kiudelis M, Bernotas J, Mickevičius A, Endzinas Ž, Maleckas A. Risk factors of esophagojejunal anastomosis leakage after total gastrectomy. Lithuanian Surgery 2013; 12: 20-4.

APA	Çetin D, Çiyiltepe H, aday u, değer k, Duman M (2019). Risk factors and laboratory markers used to predict leakage in esophagojejunal anastomotic leakage after total gastrectomy. , 6 - 12.
Chicago	Çetin Durmuş Ali,Çiyiltepe Hüseyin,aday ulas,değer kamuran cumhur,Duman Mustafa Risk factors and laboratory markers used to predict leakage in esophagojejunal anastomotic leakage after total gastrectomy. (2019): 6 - 12.
MLA	Çetin Durmuş Ali,Çiyiltepe Hüseyin,aday ulas,değer kamuran cumhur,Duman Mustafa Risk factors and laboratory markers used to predict leakage in esophagojejunal anastomotic leakage after total gastrectomy. , 2019, ss.6 - 12.
AMA	Çetin D,Çiyiltepe H,aday u,değer k,Duman M Risk factors and laboratory markers used to predict leakage in esophagojejunal anastomotic leakage after total gastrectomy. . 2019; 6 - 12.
Vancouver	Çetin D,Çiyiltepe H,aday u,değer k,Duman M Risk factors and laboratory markers used to predict leakage in esophagojejunal anastomotic leakage after total gastrectomy. . 2019; 6 - 12.
IEEE	Çetin D,Çiyiltepe H,aday u,değer k,Duman M "Risk factors and laboratory markers used to predict leakage in esophagojejunal anastomotic leakage after total gastrectomy." , ss.6 - 12, 2019.
ISNAD	Çetin, Durmuş Ali vd. "Risk factors and laboratory markers used to predict leakage in esophagojejunal anastomotic leakage after total gastrectomy". (2019), 6-12.

APA	Çetin D, Çiyiltepe H, aday u, değer k, Duman M (2019). Risk factors and laboratory markers used to predict leakage in esophagojejunal anastomotic leakage after total gastrectomy. Turkish Journal of Surgery, 35(1), 6 - 12.
Chicago	Çetin Durmuş Ali,Çiyiltepe Hüseyin,aday ulas,değer kamuran cumhur,Duman Mustafa Risk factors and laboratory markers used to predict leakage in esophagojejunal anastomotic leakage after total gastrectomy. Turkish Journal of Surgery 35, no.1 (2019): 6 - 12.
MLA	Çetin Durmuş Ali,Çiyiltepe Hüseyin,aday ulas,değer kamuran cumhur,Duman Mustafa Risk factors and laboratory markers used to predict leakage in esophagojejunal anastomotic leakage after total gastrectomy. Turkish Journal of Surgery, vol.35, no.1, 2019, ss.6 - 12.
AMA	Çetin D,Çiyiltepe H,aday u,değer k,Duman M Risk factors and laboratory markers used to predict leakage in esophagojejunal anastomotic leakage after total gastrectomy. Turkish Journal of Surgery. 2019; 35(1): 6 - 12.
Vancouver	Çetin D,Çiyiltepe H,aday u,değer k,Duman M Risk factors and laboratory markers used to predict leakage in esophagojejunal anastomotic leakage after total gastrectomy. Turkish Journal of Surgery. 2019; 35(1): 6 - 12.
IEEE	Çetin D,Çiyiltepe H,aday u,değer k,Duman M "Risk factors and laboratory markers used to predict leakage in esophagojejunal anastomotic leakage after total gastrectomy." Turkish Journal of Surgery, 35, ss.6 - 12, 2019.
ISNAD	Çetin, Durmuş Ali vd. "Risk factors and laboratory markers used to predict leakage in esophagojejunal anastomotic leakage after total gastrectomy". Turkish Journal of Surgery 35/1 (2019), 6-12.