Abstract
Since esophagojejunostomy leak (EJL) after gastrectomy is a potentially fatal complication and may impact the survival of patients with advanced gastric cancer (GC), it is important to establish risk factors for the EJL and to prevent this surgical complication. The aim of this study was analysis of predictors for the postoperative clinically apparent EJL. All patients operated for advanced GC between October 2016 and December 2019 were analyzed from a prospectively maintained database. The evaluation of the EJL and postoperative complications according to the demographic and clinical (categorized) variables was performed with odds ratio test (multivariate analysis was performed with the use of logistic regression method). Among the 114 patients included in the study, 71.1% received neoadjuvant chemotherapy and 19.3% underwent gastrectomy followed by the hyperthermic intraperitoneal chemotherapy (HIPEC). Postoperative EJL was found in 4.6% patients. The risk of EJL was significantly higher for mixed-type GC (OR = 12.45, 95% CI: 1.03–150.10; p = 0.0472). The risk of other postoperative complications was significantly higher in patients undergoing HIPEC (OR = 3.88, 95% CI: 1.40–10.80, p = 0.0094). The number of lymph nodes removed (>38) was characterized by 80% sensitivity and 79.6% specificity in predicting EJL (AUC = 0.80, 95% CI: 0.72–0.87; p < 0.0001). Mixed histological type of GC is a tumor-related risk factor for the EJL. HIPEC was confirmed to be a risk factor for postoperative complications after gastrectomy.
Highlights
Gastric cancer (GC) is the fifth most frequently diagnosed cancer, with over 1,000,000 new cases and 783,000 deaths in 2018, which makes it the third leading cause of cancer death worldwide [1].The preferred treatment for advanced, non-metastatic GC is gastrectomy with D2 lymph node dissection
According to the Japanese Gastric Cancer Association, patients with early tumors excluded from endoscopic treatment, can undergo organ-sparing surgery, such as pylorus-preserving gastrectomy and proximal gastrectomy [2]
The risk of the esophagojejunostomy leak (EJL) was significantly higher for the mixed type compared to other histological types of GC (OR = 12.45, 95% CI: 1.03–150.10; p = 0.0472; adjusted)
Summary
Gastric cancer (GC) is the fifth most frequently diagnosed cancer, with over 1,000,000 new cases and 783,000 deaths in 2018, which makes it the third leading cause of cancer death worldwide [1]. The preferred treatment for advanced, non-metastatic GC is (total) gastrectomy with D2 lymph node dissection. According to the Japanese Gastric Cancer Association, patients with early tumors excluded from endoscopic treatment (cT1N0), can undergo organ-sparing surgery, such as pylorus-preserving gastrectomy and proximal gastrectomy [2]. In most Asian countries, non-cardia (distal) GC occurs more frequently than cardia (proximal) GC. In some Western populations with GC incidence rates lower than the global average, cardia (proximal) GC rates are similar or even higher than distal GC, in men Cancers 2020, 12, 1701; doi:10.3390/cancers12061701 www.mdpi.com/journal/cancers (male-to-female ratio 3:1) [3]. The Laurén classification of GC is widely used in clinical practice, since it reflects GC morphology, epidemiology, tumor biology, clinical management and outcome [4]
Sign-in/Register to view highlights & summary Sign-in/Register to access full text options 
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a callDisclaimer: All third-party content on this website/platform is and will remain the property of their respective owners and is provided on "as is" basis without any warranties, express or implied. Use of third-party content does not indicate any affiliation, sponsorship with or endorsement by them. Any references to third-party content is to identify the corresponding services and shall be considered fair use under The CopyrightLaw.
