Abstract
BackgroundAnastomotic leakage (AL) after gastrectomy in gastric cancer patients is associated with high mortality rates. Various endoscopic procedures are available to manage this postoperative complication. The aim of study was to evaluate the outcome of two endoscopic modalities, clippings and stents, for the treatment of AL.Patients and methodsThere were 4916 gastric cancer patients who underwent gastrectomy between December 2007 and January 2016 at the National Cancer Center, Korea. A total of 115 patients (2.3%) developed AL. Of these, 85 patients (1.7%) received endoscopic therapy for AL and were included in this retrospective study. The endpoints were the complete leakage closure rates and risk factors associated with failure of endoscopic therapy.ResultsOf the 85 patients, 62 received endoscopic clippings (with or without detachable snares), and 23 received a stent insertion. Overall, the complete leakage closure rate was 80%, and no significant difference was found between the clipping and stent groups (79.0% vs. 82.6%, respectively; P = 0.89). The complete leakage closure rate was significantly lower in the duodenal and jejunal stump sites (60%) than esophageal sites (86.1%) and gastric sites (94.1%; P = 0.026). The multivariate analysis showed that stump leakage sites (adjusted odds ratio [aOR], 4.51; P = 0.031) and the presence of intra-abdominal abscess (aOR, 4.92; P = -0.025) were associated with unsuccessful leakage closures.ConclusionsEndoscopic therapy using clippings or stents is an effective method for the postoperative management of AL in gastric cancer patients. This therapy can be considered a primary treatment option due to its demonstrated efficacy, safety, and minimally invasive nature.
Highlights
Anastomotic leakage (AL) after gastrectomy in gastric cancer patients is associated with high mortality rates
We reviewed the medical records of these patients, and those who developed AL after gastrectomy were considered for inclusion in this study
Previous studies investigating the efficacy of endoscopic management of AL after upper gastrointestinal surgery were limited by small case numbers [17,18,19,20,21] and heterogeneous groups of patients who underwent surgery due to differing diagnoses [19, 20]
Summary
Anastomotic leakage (AL) after gastrectomy in gastric cancer patients is associated with high mortality rates. The endpoints were the complete leakage closure rates and risk factors associated with failure of endoscopic therapy. The complete leakage closure rate was 80%, and no significant difference was found between the clipping and stent groups (79.0% vs 82.6%, respectively; P = 0.89). Conclusions Endoscopic therapy using clippings or stents is an effective method for the postoperative management of AL in gastric cancer patients. This therapy can be considered a primary treatment option due to its demonstrated efficacy, safety, and minimally invasive nature
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