Incidence and treatment outcomes of leakage after gastrectomy for gastric cancer: Experience of 14,075 patients from a large volume centre

Chul Kyu Roh, Seohee Choi, Won Jun Seo, Minah Cho, Hyoung Il Kim, Sang Kil Lee, Joon Seok Lim, Woo Jin Hyung

Research output: Contribution to journalArticlepeer-review

3 Citations (Scopus)

Abstract

Introduction: Leakage is a serious and potentially fatal complication of gastrectomy for gastric cancer. However, comprehensive reports regarding leakage after gastrectomy remain limited. We aimed to evaluate the incidence and treatment outcomes of leakage after gastrectomy for cancer. Methods: We reviewed the prospectively collected data of 14,075 Patients who underwent gastrectomy for gastric cancer between 2005 and 2017. Outcomes included incidence, risk factors of leakage, and leakage treatment outcomes. Results: The median day of leakage detection was postoperative day 7 (range 1–29days). The overall leakage incidence was 1.51% (213/14,075), and the most frequent location was the oesophagojejunostomy (2.07%). Leakage after total gastrectomy was more frequent with minimally invasive surgery (open:1.64%, laparoscopic:3.56%, robotic:5.83%; P < 0.001). Leakage incidence was higher in the surgeon's initial 100 cases than in later cases (2.4 vs. 1.3%; P < 0.001), especially with minimally invasive surgery. Early leakage (within 4 days of surgery) occurred more often after minimally invasive surgery (open:12.7%, laparoscopic:35.4%, robotic:29.0%; P = 0.006). The success rate for initial treatment of leakage was 70.4% (150/213). Surgery after initial treatment failure demonstrated a higher success rate for early leakage than for late leakage (80.0 vs. 22.2%). Among 213 patients who experienced leakage, fifteen patients (7.0%) died, and leakage-related mortality accounted for 38.5% (15/39) of all surgery-related mortality after gastrectomy. Conclusions: Leakage after gastric cancer surgery is associated with high mortality. Improved surgeon experience using minimally invasive techniques is required to reduce the risk of leakage. Surgery is an effective treatment for early leakage, although further studies are needed to establish the most appropriate treatment strategies.

Original languageEnglish
Pages (from-to)2304-2312
Number of pages9
JournalEuropean Journal of Surgical Oncology
Volume47
Issue number9
DOIs
Publication statusPublished - 2021 Sep

Bibliographical note

Funding Information:
Dr. WJ Hyung reports receiving research grants from Medtronic, and is the chief strategic officer and a stockholder of Hutom. Dr. Hyung has also provided consultancy services to Ethicon and Verb Surgical, which are unrelated to the submitted work. All other authors declare no conflicts of interest.

Publisher Copyright:
© 2021 Elsevier Ltd, BASO ~ The Association for Cancer Surgery, and the European Society of Surgical Oncology

All Science Journal Classification (ASJC) codes

  • Surgery
  • Oncology

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