Novel abdominal negative pressure lavage-drainage system for anastomotic leakage after R0 resection for gastric cancer
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摘要
BACKGROUND Anastomotic leakage(AL) is a severe complication associated with high morbidity and mortality after radical gastrectomy(RG) for gastric cancer(GC).We hypothesized that a novel abdominal negative pressure lavage-drainage system(ANPLDS) can effectively reduce the failure-to-rescue(FTR) and the risk of reoperation, and it is a feasible management for AL.AIM To report our institution's experience with a novel ANPLDS for AL after RG for GC.METHODS The study enrolled 4173 patients who underwent R0 resection for GC at our institution between June 2009 and December 2016. ANPLDS was routinely used for patients with AL after January 2014. Characterization of patients who underwent R0 resection was compared between different study periods. AL rates and postoperative outcome among patients with AL were compared before and after the ANPLDS therapy. We used multivariate analyses to evaluate clinicopathological and perioperative factors for associations with AL and FTR after AL.RESULTS AL occurred in 83(83/4173, 2%) patients, leading to 7 deaths. The mean time of occurrence of AL was 5.6 days. The AL rate was similar before(2009-2013, period1) and after(2014-2016, period 2) the implementation of the ANPLDS therapy(1.7% vs 2.3%, P = 0.121). Age and malnourishment were independently associated with AL. The FTR rate and abdominal bleeding rate after AL occurred were respectively 8.4% and 9.6% for the entire period; however, compared with period 1, this significantly decreased during period 2(16.2% vs 2.2%, P = 0.041;18.9% vs 2.2%, P = 0.020, respectively). Moreover, the reoperation rate was also reduced in period 2, although this result was not statistically significant(13.5% vs2.2%, P = 0.084). Additionally, only ANPLDS therapy was an independent protective factor for FTR after AL(P = 0.04).CONCLUSION Our experience demonstrates that ANPLDS is a feasible management for AL after RG for GC.
BACKGROUND Anastomotic leakage(AL) is a severe complication associated with high morbidity and mortality after radical gastrectomy(RG) for gastric cancer(GC).We hypothesized that a novel abdominal negative pressure lavage-drainage system(ANPLDS) can effectively reduce the failure-to-rescue(FTR) and the risk of reoperation, and it is a feasible management for AL.AIM To report our institution's experience with a novel ANPLDS for AL after RG for GC.METHODS The study enrolled 4173 patients who underwent R0 resection for GC at our institution between June 2009 and December 2016. ANPLDS was routinely used for patients with AL after January 2014. Characterization of patients who underwent R0 resection was compared between different study periods. AL rates and postoperative outcome among patients with AL were compared before and after the ANPLDS therapy. We used multivariate analyses to evaluate clinicopathological and perioperative factors for associations with AL and FTR after AL.RESULTS AL occurred in 83(83/4173, 2%) patients, leading to 7 deaths. The mean time of occurrence of AL was 5.6 days. The AL rate was similar before(2009-2013, period1) and after(2014-2016, period 2) the implementation of the ANPLDS therapy(1.7% vs 2.3%, P = 0.121). Age and malnourishment were independently associated with AL. The FTR rate and abdominal bleeding rate after AL occurred were respectively 8.4% and 9.6% for the entire period; however, compared with period 1, this significantly decreased during period 2(16.2% vs 2.2%, P = 0.041;18.9% vs 2.2%, P = 0.020, respectively). Moreover, the reoperation rate was also reduced in period 2, although this result was not statistically significant(13.5% vs2.2%, P = 0.084). Additionally, only ANPLDS therapy was an independent protective factor for FTR after AL(P = 0.04).CONCLUSION Our experience demonstrates that ANPLDS is a feasible management for AL after RG for GC.
BACKGROUND Anastomotic leakage(AL) is a severe complication associated with high morbidity and mortality after radical gastrectomy(RG) for gastric cancer(GC).We hypothesized that a novel abdominal negative pressure lavage-drainage system(ANPLDS) can effectively reduce the failure-to-rescue(FTR) and the risk of reoperation, and it is a feasible management for AL.AIM To report our institution's experience with a novel ANPLDS for AL after RG for GC.METHODS The study enrolled 4173 patients who underwent R0 resection for GC at our institution between June 2009 and December 2016. ANPLDS was routinely used for patients with AL after January 2014. Characterization of patients who underwent R0 resection was compared between different study periods. AL rates and postoperative outcome among patients with AL were compared before and after the ANPLDS therapy. We used multivariate analyses to evaluate clinicopathological and perioperative factors for associations with AL and FTR after AL.RESULTS AL occurred in 83(83/4173, 2%) patients, leading to 7 deaths. The mean time of occurrence of AL was 5.6 days. The AL rate was similar before(2009-2013, period1) and after(2014-2016, period 2) the implementation of the ANPLDS therapy(1.7% vs 2.3%, P = 0.121). Age and malnourishment were independently associated with AL. The FTR rate and abdominal bleeding rate after AL occurred were respectively 8.4% and 9.6% for the entire period; however, compared with period 1, this significantly decreased during period 2(16.2% vs 2.2%, P = 0.041;18.9% vs 2.2%, P = 0.020, respectively). Moreover, the reoperation rate was also reduced in period 2, although this result was not statistically significant(13.5% vs2.2%, P = 0.084). Additionally, only ANPLDS therapy was an independent protective factor for FTR after AL(P = 0.04).CONCLUSION Our experience demonstrates that ANPLDS is a feasible management for AL after RG for GC.
引文
1 Inokuchi M,Otsuki S,Fujimori Y,Sato Y,Nakagawa M,Kojima K.Systematic review of anastomotic complications of esophagojejunostomy after laparoscopic total gastrectomy.World JGastroenterol 2015;21:9656-9665[PMID:26327774 DOI:10.3748/wjg.v21.i32.9656]
2 Meyer L,Meyer F,Dralle H,Ernst M,Lippert H,Gastinger I;East German Study Group for Quality Control in Operative Medicine and Regional Development in Surgery.Insufficiency risk of esophagojejunal anastomosis after total abdominal gastrectomy for gastric carcinoma.Langenbecks Arch Surg 2005;390:510-516[PMID:16086189 DOI:10.1007/s00423-005-0575-2]
3 Ichikawa D,Kurioka H,Yamaguchi T,Koike H,Okamoto K,Otsuji E,Shirono K,Shioaki Y,Ikeda E,Mutoh F,Yamagishi H.Postoperative complications following gastrectomy for gastric cancer during the last decade.Hepatogastroenterology 2004;51:613-617[PMID:15086217]
4 Lang H,Piso P,Stukenborg C,Raab R,J?hne J.Management and results of proximal anastomotic leaks in a series of 1114 total gastrectomies for gastric carcinoma.Eur J Surg Oncol 2000;26:168-171[PMID:10744938 DOI:10.1053/ejso.1999.0764]
5 Wang Z,Chen J,Su K,Dong Z.Abdominal drainage versus no drainage post-gastrectomy for gastric cancer.Cochrane Database Syst Rev 2015;CD008788[PMID:25961741 DOI:10.1002/14651858.CD008788.pub3]
6 Kim J,Lee J,Hyung WJ,Cheong JH,Chen J,Choi SH,Noh SH.Gastric cancer surgery without drains:a prospective randomized trial.J Gastrointest Surg 2004;8:727-732[PMID:15358335 DOI:10.1016/j.gassur.2004.05.018]
7 Lee J,Choi YY,An JY,Seo SH,Kim DW,Seo YB,Nakagawa M,Li S,Cheong JH,Hyung WJ,Noh SH.Do All Patients Require Prophylactic Drainage After Gastrectomy for Gastric Cancer?The Experience of a High-Volume Center.Ann Surg Oncol 2015;22:3929-3937[PMID:25845430 DOI:10.1245/s10434-015-4521-4]
8 Shrikhande SV,Barreto SG,Shetty G,Suradkar K,Bodhankar YD,Shah SB,Goel M.Postoperative abdominal drainage following major upper gastrointestinal surgery:single drain versus two drains.J Cancer Res Ther 2013;9:267-271[PMID:23771371 DOI:10.4103/0973-1482.113380]
9 Liu HP,Zhang YC,Zhang YL,Yin LN,Wang J.Drain versus no-drain after gastrectomy for patients with advanced gastric cancer:systematic review and meta-analysis.Dig Surg 2011;28:178-189[PMID:21540606 DOI:10.1159/000323954]
10 Petrowsky H,Demartines N,Rousson V,Clavien PA.Evidence-based value of prophylactic drainage in gastrointestinal surgery:a systematic review and meta-analyses.Ann Surg 2004;240:1074-84;discussion 1084-5[PMID:15570212]
11 Japanese Gastric Cancer Association.Japanese gastric cancer treatment guidelines 2010(ver.3).Gastric Cancer 2011;14:113-123[PMID:21573742 DOI:10.1007/s10120-011-0042-4]
12 Amin MB,Edge S,Greene F,Byrd DR,Brookland RK,Washington MK,Gershenwald JE,Compton CC,Hess KR,Sullivan DC,Jessup JM,Brierley JD,Gaspar LE,Schilsky RL,Balch CM,Winchester DP,Asare EA,Madera M,Gress DM,Meyer LR.AJCC Cancer Staging Manual.New York:Springer;2017
13 Schardey HM,Joosten U,Finke U,Staubach KH,Schauer R,Heiss A,Kooistra A,Rau HG,Nibler R,Lüdeling S,Unertl K,Ruckdeschel G,Exner H,Schildberg FW.The prevention of anastomotic leakage after total gastrectomy with local decontamination.A prospective,randomized,double-blind,placebo-controlled multicenter trial.Ann Surg 1997;225:172-180[PMID:9065294]
14 Park JS,Choi GS,Kim SH,Kim HR,Kim NK,Lee KY,Kang SB,Kim JY,Lee KY,Kim BC,Bae BN,Son GM,Lee SI,Kang H.Multicenter analysis of risk factors for anastomotic leakage after laparoscopic rectal cancer excision:the Korean laparoscopic colorectal surgery study group.Ann Surg 2013;257:665-671[PMID:23333881 DOI:10.1097/SLA.0b013e31827b8ed9]
15 Tevis SE,Carchman EH,Foley EF,Heise CP,Harms BA,Kennedy GD.Does Anastomotic Leak Contribute to High Failure-to-rescue Rates?Ann Surg 2016;263:1148-1151[PMID:26587851 DOI:10.1097/SLA.0000000000001409]
16 Passot G,Vaudoyer D,Villeneuve L,Wallet F,Beaujard AC,Boschetti G,Rousset P,Bakrin N,Cotte E,Glehen O.A Perioperative Clinical Pathway Can Dramatically Reduce Failure-to-rescue Rates After Cytoreductive Surgery for Peritoneal Carcinomatosis:A Retrospective Study of 666Consecutive Cytoreductions.Ann Surg 2017;265:806-813[PMID:27775553 DOI:10.1097/SLA.0000000000001723]
17 Weimann A,Braga M,Harsanyi L,Laviano A,Ljungqvist O,Soeters P,Jauch KW,Kemen M,Hiesmayr JM,Horbach T,Kuse ER,Vestweber KH;DGEM(German Society for Nutritional Medicine),ESPEN(European Society for Parenteral and Enteral Nutrition).ESPEN Guidelines on Enteral Nutrition:Surgery including organ transplantation.Clin Nutr 2006;25:224-244[PMID:16698152 DOI:10.1016/j.clnu.2006.01.015]
18 Fukuda Y,Yamamoto K,Hirao M,Nishikawa K,Maeda S,Haraguchi N,Miyake M,Hama N,Miyamoto A,Ikeda M,Nakamori S,Sekimoto M,Fujitani K,Tsujinaka T.Prevalence of Malnutrition Among Gastric Cancer Patients Undergoing Gastrectomy and Optimal Preoperative Nutritional Support for Preventing Surgical Site Infections.Ann Surg Oncol 2015;22Suppl 3:S778-S785[PMID:26286199 DOI:10.1245/s10434-015-4820-9]
19 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;36:1617-1622[PMID:22415758 DOI:10.1007/s00268-012-1559-3]
20 Kim CW,Baek SJ,Hur H,Min BS,Baik SH,Kim NK.Anastomotic Leakage After Low Anterior Resection for Rectal Cancer Is Different Between Minimally Invasive Surgery and Open Surgery.Ann Surg 2016;263:130-137[PMID:25692355 DOI:10.1097/SLA.0000000000001157]
21 Migita K,Takayama T,Matsumoto S,Wakatsuki K,Enomoto K,Tanaka T,Ito M,Nakajima Y.Risk factors for esophagojejunal anastomotic leakage after elective gastrectomy for gastric cancer.J Gastrointest Surg 2012;16:1659-1665[PMID:22688419 DOI:10.1007/s11605-012-1932-4]
22 Schietroma M,Cecilia EM,Carlei F,Sista F,De Santis G,Piccione F,Amicucci G.Prevention of anastomotic leakage after total gastrectomy with perioperative supplemental oxygen administration:a prospective randomized,double-blind,controlled,single-center trial.Ann Surg Oncol 2013;20:1584-1590[PMID:23099730 DOI:10.1245/s10434-012-2714-7]
23 Tu RH,Lin JX,Zheng CH,Li P,Xie JW,Wang JB,Lu J,Chen QY,Cao LL,Lin M,Huang CM.Development of a nomogram for predicting the risk of anastomotic leakage after a gastrectomy for gastric cancer.Eur J Surg Oncol 2017;43:485-492[PMID:28041649 DOI:10.1016/j.ejso.2016.11.022]
24 Lin C,Zhang Z,Wang Y,Huang S,Wang L,Wang B.[Continuous negative pressure-flush through extraperitoneal dual tube in the treatment and prevention for rectal cancer patients with anastomotic leakage after low anterior resection].Zhonghua Wei Chang Wai Ke Za Zhi 2014;17:469-472[PMID:24859957]
25 Jiang K,Zhang W,Feng Y,Su M,Dong J,Huang Z.Enclosed passive infraversion lavagedrainage system(EPILDS):a novel safe technique for local management of early stage bile leakage and pancreatic fistula Post Pancreatoduodenectomy.Cell Biochem Biophys 2014;68:541-546[PMID:24006154 DOI:10.1007/s12013-013-9735-0]
26 Glance LG,Dick AW,Meredith JW,Mukamel DB.Variation in hospital complication rates and failure-to-rescue for trauma patients.Ann Surg 2011;253:811-816[PMID:21475024 DOI:10.1097/SLA.0b013e318211d872]
27 Sheetz KH,Dimick JB,Ghaferi AA.Impact of Hospital Characteristics on Failure to Rescue Following Major Surgery.Ann Surg 2016;263:692-697[PMID:26501706 DOI:10.1097/SLA.0000000000001414]
2 Meyer L,Meyer F,Dralle H,Ernst M,Lippert H,Gastinger I;East German Study Group for Quality Control in Operative Medicine and Regional Development in Surgery.Insufficiency risk of esophagojejunal anastomosis after total abdominal gastrectomy for gastric carcinoma.Langenbecks Arch Surg 2005;390:510-516[PMID:16086189 DOI:10.1007/s00423-005-0575-2]
3 Ichikawa D,Kurioka H,Yamaguchi T,Koike H,Okamoto K,Otsuji E,Shirono K,Shioaki Y,Ikeda E,Mutoh F,Yamagishi H.Postoperative complications following gastrectomy for gastric cancer during the last decade.Hepatogastroenterology 2004;51:613-617[PMID:15086217]
4 Lang H,Piso P,Stukenborg C,Raab R,J?hne J.Management and results of proximal anastomotic leaks in a series of 1114 total gastrectomies for gastric carcinoma.Eur J Surg Oncol 2000;26:168-171[PMID:10744938 DOI:10.1053/ejso.1999.0764]
5 Wang Z,Chen J,Su K,Dong Z.Abdominal drainage versus no drainage post-gastrectomy for gastric cancer.Cochrane Database Syst Rev 2015;CD008788[PMID:25961741 DOI:10.1002/14651858.CD008788.pub3]
6 Kim J,Lee J,Hyung WJ,Cheong JH,Chen J,Choi SH,Noh SH.Gastric cancer surgery without drains:a prospective randomized trial.J Gastrointest Surg 2004;8:727-732[PMID:15358335 DOI:10.1016/j.gassur.2004.05.018]
7 Lee J,Choi YY,An JY,Seo SH,Kim DW,Seo YB,Nakagawa M,Li S,Cheong JH,Hyung WJ,Noh SH.Do All Patients Require Prophylactic Drainage After Gastrectomy for Gastric Cancer?The Experience of a High-Volume Center.Ann Surg Oncol 2015;22:3929-3937[PMID:25845430 DOI:10.1245/s10434-015-4521-4]
8 Shrikhande SV,Barreto SG,Shetty G,Suradkar K,Bodhankar YD,Shah SB,Goel M.Postoperative abdominal drainage following major upper gastrointestinal surgery:single drain versus two drains.J Cancer Res Ther 2013;9:267-271[PMID:23771371 DOI:10.4103/0973-1482.113380]
9 Liu HP,Zhang YC,Zhang YL,Yin LN,Wang J.Drain versus no-drain after gastrectomy for patients with advanced gastric cancer:systematic review and meta-analysis.Dig Surg 2011;28:178-189[PMID:21540606 DOI:10.1159/000323954]
10 Petrowsky H,Demartines N,Rousson V,Clavien PA.Evidence-based value of prophylactic drainage in gastrointestinal surgery:a systematic review and meta-analyses.Ann Surg 2004;240:1074-84;discussion 1084-5[PMID:15570212]
11 Japanese Gastric Cancer Association.Japanese gastric cancer treatment guidelines 2010(ver.3).Gastric Cancer 2011;14:113-123[PMID:21573742 DOI:10.1007/s10120-011-0042-4]
12 Amin MB,Edge S,Greene F,Byrd DR,Brookland RK,Washington MK,Gershenwald JE,Compton CC,Hess KR,Sullivan DC,Jessup JM,Brierley JD,Gaspar LE,Schilsky RL,Balch CM,Winchester DP,Asare EA,Madera M,Gress DM,Meyer LR.AJCC Cancer Staging Manual.New York:Springer;2017
13 Schardey HM,Joosten U,Finke U,Staubach KH,Schauer R,Heiss A,Kooistra A,Rau HG,Nibler R,Lüdeling S,Unertl K,Ruckdeschel G,Exner H,Schildberg FW.The prevention of anastomotic leakage after total gastrectomy with local decontamination.A prospective,randomized,double-blind,placebo-controlled multicenter trial.Ann Surg 1997;225:172-180[PMID:9065294]
14 Park JS,Choi GS,Kim SH,Kim HR,Kim NK,Lee KY,Kang SB,Kim JY,Lee KY,Kim BC,Bae BN,Son GM,Lee SI,Kang H.Multicenter analysis of risk factors for anastomotic leakage after laparoscopic rectal cancer excision:the Korean laparoscopic colorectal surgery study group.Ann Surg 2013;257:665-671[PMID:23333881 DOI:10.1097/SLA.0b013e31827b8ed9]
15 Tevis SE,Carchman EH,Foley EF,Heise CP,Harms BA,Kennedy GD.Does Anastomotic Leak Contribute to High Failure-to-rescue Rates?Ann Surg 2016;263:1148-1151[PMID:26587851 DOI:10.1097/SLA.0000000000001409]
16 Passot G,Vaudoyer D,Villeneuve L,Wallet F,Beaujard AC,Boschetti G,Rousset P,Bakrin N,Cotte E,Glehen O.A Perioperative Clinical Pathway Can Dramatically Reduce Failure-to-rescue Rates After Cytoreductive Surgery for Peritoneal Carcinomatosis:A Retrospective Study of 666Consecutive Cytoreductions.Ann Surg 2017;265:806-813[PMID:27775553 DOI:10.1097/SLA.0000000000001723]
17 Weimann A,Braga M,Harsanyi L,Laviano A,Ljungqvist O,Soeters P,Jauch KW,Kemen M,Hiesmayr JM,Horbach T,Kuse ER,Vestweber KH;DGEM(German Society for Nutritional Medicine),ESPEN(European Society for Parenteral and Enteral Nutrition).ESPEN Guidelines on Enteral Nutrition:Surgery including organ transplantation.Clin Nutr 2006;25:224-244[PMID:16698152 DOI:10.1016/j.clnu.2006.01.015]
18 Fukuda Y,Yamamoto K,Hirao M,Nishikawa K,Maeda S,Haraguchi N,Miyake M,Hama N,Miyamoto A,Ikeda M,Nakamori S,Sekimoto M,Fujitani K,Tsujinaka T.Prevalence of Malnutrition Among Gastric Cancer Patients Undergoing Gastrectomy and Optimal Preoperative Nutritional Support for Preventing Surgical Site Infections.Ann Surg Oncol 2015;22Suppl 3:S778-S785[PMID:26286199 DOI:10.1245/s10434-015-4820-9]
19 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;36:1617-1622[PMID:22415758 DOI:10.1007/s00268-012-1559-3]
20 Kim CW,Baek SJ,Hur H,Min BS,Baik SH,Kim NK.Anastomotic Leakage After Low Anterior Resection for Rectal Cancer Is Different Between Minimally Invasive Surgery and Open Surgery.Ann Surg 2016;263:130-137[PMID:25692355 DOI:10.1097/SLA.0000000000001157]
21 Migita K,Takayama T,Matsumoto S,Wakatsuki K,Enomoto K,Tanaka T,Ito M,Nakajima Y.Risk factors for esophagojejunal anastomotic leakage after elective gastrectomy for gastric cancer.J Gastrointest Surg 2012;16:1659-1665[PMID:22688419 DOI:10.1007/s11605-012-1932-4]
22 Schietroma M,Cecilia EM,Carlei F,Sista F,De Santis G,Piccione F,Amicucci G.Prevention of anastomotic leakage after total gastrectomy with perioperative supplemental oxygen administration:a prospective randomized,double-blind,controlled,single-center trial.Ann Surg Oncol 2013;20:1584-1590[PMID:23099730 DOI:10.1245/s10434-012-2714-7]
23 Tu RH,Lin JX,Zheng CH,Li P,Xie JW,Wang JB,Lu J,Chen QY,Cao LL,Lin M,Huang CM.Development of a nomogram for predicting the risk of anastomotic leakage after a gastrectomy for gastric cancer.Eur J Surg Oncol 2017;43:485-492[PMID:28041649 DOI:10.1016/j.ejso.2016.11.022]
24 Lin C,Zhang Z,Wang Y,Huang S,Wang L,Wang B.[Continuous negative pressure-flush through extraperitoneal dual tube in the treatment and prevention for rectal cancer patients with anastomotic leakage after low anterior resection].Zhonghua Wei Chang Wai Ke Za Zhi 2014;17:469-472[PMID:24859957]
25 Jiang K,Zhang W,Feng Y,Su M,Dong J,Huang Z.Enclosed passive infraversion lavagedrainage system(EPILDS):a novel safe technique for local management of early stage bile leakage and pancreatic fistula Post Pancreatoduodenectomy.Cell Biochem Biophys 2014;68:541-546[PMID:24006154 DOI:10.1007/s12013-013-9735-0]
26 Glance LG,Dick AW,Meredith JW,Mukamel DB.Variation in hospital complication rates and failure-to-rescue for trauma patients.Ann Surg 2011;253:811-816[PMID:21475024 DOI:10.1097/SLA.0b013e318211d872]
27 Sheetz KH,Dimick JB,Ghaferi AA.Impact of Hospital Characteristics on Failure to Rescue Following Major Surgery.Ann Surg 2016;263:692-697[PMID:26501706 DOI:10.1097/SLA.0000000000001414]