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Insufficiency risk of esophagojejunal anastomosis after total abdominal gastrectomy for gastric carcinoma

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Abstract

Background

The outcome and quality of surgical treatment in gastric cancer are closely associated with specific postoperative morbidity and mortality, in addition to an oncosurgically adequate resection status. In this context, a preventive concept of decreasing the insufficiency rate of esophageal anastomosis may have a great impact.

Method

Over a time period of 12 months (from 1 January 2002 to 31 December 2002), 1,199 patients (from 80 East German hospitals) with gastric carcinoma, carcinoma of the esophagogastral junction, or gastrointestinal stroma tumor (GIST) were enrolled in this prospective multicenter observational study with the aim of evaluating their early postoperative outcome. By means of a logistic regression analysis, independent variables, which alter significantly the healing of esophagojejunal anastomosis, were determined; in addition, their clinical impact on preventive management to lower the insufficiency rate of esophageal anastomosis was investigated.

Results

In 1,139 patients, histological investigation revealed gastric carcinoma. Out of these patients, 1,031 subjects underwent surgical intervention (90.5%) and 891 individuals underwent resection (86.4%). In 813 patients, radical resection (subtotal resection and gastrectomy) was executed (78.9%), whereas in 726 cases, R0 resection was achieved (81.5%). Gastrectomy was the preferred procedure in 649 patients, resulting in a gastrectomy rate of 62.9% relating to all patients who underwent operation (curative and palliative intention, 80.3% and 19.7%, respectively). The insufficiency rate of esophagojejunal anastomosis was 5.7% (37/649). Neither the comparison between the various procedures for the reconstruction of the esophagojejunal passage and anastomosing techniques after gastrectomy nor that between gastrectomies with curative and palliative intention revealed any significant difference. Dysphagia and gastric outlet syndrome due to a stenosis were determined as independent variables by a logistic regression analysis of all preoperative and intraoperative variables. In all patients with gastric carcinoma, both parameters were recorded in 9.9% (113/1,139) and 6.7% (76/1,139), respectively.

Conclusion

Dysphagia and gastric stenosis, which significantly influence the healing of esophagojejunal anastomosis after gastrectomy, are considered characteristics of an advanced tumor growth and a pretherapeutic lack of an adequate nutrition. This emphasizes the necessity of an early diagnosis of gastric cancer in order to lower perioperative morbidity. In addition, dysphagia is commonly associated with an obstruction of the upper gastrointestinal tract, which can lead to nutritional deficits, and thus deserves specific care during preventive management.

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Authors and Affiliations

  1. Institute for Quality Control in Operative Medicine, University Hospital, Otto-von-Guericke University, Magdeburg, Germany

    L. Meyer, F. Meyer, H. Lippert & I. Gastinger

  2. Department of Surgery, Municipal Hospital, Teaching Hospital of the Charité, Thiemstrasse 111, 03048, Cottbus, Germany

    L. Meyer & I. Gastinger

  3. Department of Surgery, University Hospital, Magdeburg, Germany

    F. Meyer & H. Lippert

  4. Department of General and Abdominal Surgery, University Hospital, Martin-Luther University, Halle, Germany

    H. Dralle

  5. Department of Surgery, Hospital Neubrandenburg, Neubrandenburg, Germany

    M. Ernst

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  1. L. Meyer
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  2. F. Meyer
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  4. M. Ernst
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  5. H. Lippert
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  6. I. Gastinger
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East German Study Group for Quality Control in Operative Medicine and Regional Development in Surgery

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Correspondence to L. Meyer.

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Meyer, L., Meyer, F., Dralle, H. et al. Insufficiency risk of esophagojejunal anastomosis after total abdominal gastrectomy for gastric carcinoma. Langenbecks Arch Surg 390, 510–516 (2005). https://doi.org/10.1007/s00423-005-0575-2

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  • DOI: https://doi.org/10.1007/s00423-005-0575-2

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