Gastrointestinal leakage after gastrectomy for gastric cancer high-volume center 10-year experience

Abstract

Purpose Gastrointestinal leakage is one of the most detrimental and life-threatening complications that may occur after gastrectomy for gastric cancer. We evaluated the incidence, predictive factors, management strategies, and outcomes of gastrointestinal leakage following gastrectomy for gastric cancer in a high-volume center over a 10-year period and the impact of prospective continuous monitoring of management outcomes. Patients and methods A total of 7098 patients who underwent curative radical gastrectomy for gastric adenocarcinoma from January 2012 to December 2021 in Gastrointestinal Surgery Department, Seoul National University Hospital were reviewed. Results The overall incidence of gastrointestinal leakage was 2.8% (198/7098). Old age (>60), male sex, high BMI (≥25), prolonged operative time (>240 min), open approach, and increased lymph node ratio (>5%) were important risk factors for anastomotic leakage following gastrectomy on multivariate analysis. Leakage increased postoperative hospital stay by fivefolds and was responsible for 20.5% of major complications after gastrectomy. Interventional management was performed in 76.8% of leakage cases while surgery was required in 9.6% of cases with success of initial treatment in 83.8% of patients. Mortality rate was 1.5% (3/198). Conclusion Prospective, transparent, and accurate data collection is an essential component of self-improvement cycle. Surgeon experience is an important factor especially in esophagojejunal anastomosis with tension free well vascularized pedicle is the key. Multidisciplinary team management of leakage with efficient interventional strategies can greatly improve the leakage outcome.