Reconstruction Techniques and Associated Morbidity in Minimally Invasive Gastrectomy for Cancer: Insights From the GastroBenchmark and GASTRODATA databases.

IF 7.5 1区 医学 Q1 SURGERY Annals of surgery Pub Date : 2024-11-01 Epub Date: 2024-08-05 DOI:10.1097/SLA.0000000000006470
Marcel André Schneider, Jeesun Kim, Felix Berlth, Yutaka Sugita, Peter P Grimminger, Bas P L Wijnhoven, Hidde Overtoom, Ines Gockel, René Thieme, Ewen A Griffiths, William Butterworth, Henrik Nienhüser, Beat Müller, Nerma Crnovrsanin, Daniel Gero, Felix Nickel, Suzanne Gisbertz, Mark I van Berge Henegouwen, Philip H Pucher, Kashuf Khan, Asif Chaudry, Pranav H Patel, Manuel Pera, Mariagiulia Dal Cero, Carlos Garcia, Guillermo Martinez Salinas, Paulo Kassab, Osvaldo Antônio Prado Castro, Enrique Norero, Paul Wisniowski, Luke Randall Putnam, Pietro Maria Lombardi, Giovanni Ferrari, Rita Gudaityte, Almantas Maleckas, Leanne Prodehl, Antonio Castaldi, Michel Prudhomme, Hyuk-Joon Lee, Takeshi Sano, Gian Luca Baiocchi, Giovanni De Manzoni, Simone Giacopuzzi, Maria Bencivenga, Riccardo Rosati, Francesco Puccetti, Domenico D'Ugo, Souya Nunobe, Han-Kwang Yang, Christian Alexander Gutschow
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引用次数: 0

Abstract

Objective/background: Various anastomotic and reconstruction techniques are used for minimally invasive total (miTG) and distal gastrectomy (miDG). Their effects on postoperative morbidity have not been extensively studied.

Methods: MiTG and miDG patients were selected from 9356 oncological gastrectomies performed in 2017-2021 in 43 centers. Endpoints included anastomotic leakage (AL) rate and postoperative morbidity tested by multivariable analysis.

Results: Three major anastomotic techniques [circular stapled (CS); linear stapled (LS); and hand sewn (HS)], and 3 major bowel reconstruction types [Roux (RX); Billroth I (BI); Billroth II (BII)] were identified in miTG (n=878) and miDG (n=3334). Postoperative complications, including AL (5.2% vs 1.1%), overall (28.7% vs 16.3%), and major morbidity (15.7% vs 8.2%), as well as 90-day mortality (1.6% vs 0.5%) were higher after miTG compared with miDG. After miTG, the AL rate was higher after CS (4.3%) and HS (7.9%) compared with LS (3.4%). Similarly, major complications (LS: 9.7%, CS: 16.2%, and HS: 12.7%) were lowest after LS. Multivariate analysis confirmed anastomotic technique as a predictive factor for AL, overall, and major complications. In miDG, AL rate (BI: 1.4%, BII 0.8%, and RX 1.2%), overall (BI: 14.5%, BII: 15.0%, and RX: 18.7%), and major morbidity (BI: 7.9%, BII: 9.1%, and RX: 7.2%), and mortality (BI: 0%, BII: 0.1%, and RY: 1.1%%) were not affected by bowel reconstruction.

Conclusions: In oncologically suitable situations, miDG should be preferred to miTG, as postoperative morbidity is significantly lower. LS should be a preferred anastomotic technique for miTG in Western Centers. Conversely, bowel reconstruction in DG may be chosen according to the surgeon's preference.

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癌症微创胃切除术中的重建技术和相关发病率--来自 GastroBenchmark 和 GASTRODATA 数据库的启示。
目的/背景:微创全胃切除术(miTG)和远端胃切除术(miDG)采用了多种吻合和重建技术。这些技术对术后发病率的影响尚未得到广泛研究:从 44 个中心 2017-2021 年进行的 9356 例肿瘤胃切除术中选取 MiTG 和 miDG 患者。终点包括吻合口漏(AL)率和术后发病率,通过多变量分析进行检验:在miTG(n=878)和miDG(n=3334)中确定了三种主要吻合技术(环形缝合(CS);线性缝合(LS);手缝(HS))和三种主要肠道重建类型(Roux(RX);Billroth I(BI);Billroth II(BII))。与 miDG 相比,miTG 术后并发症包括 AL(5.2% 对 1.1%)、总发病率(28.7% 对 16.3%)和主要发病率(15.7% 对 8.2%)以及 90 天死亡率(1.6% 对 0.5%)更高。miTG 后,CS(4.3%)和 HS(7.9%)的 AL 率高于 LS(3.4%)。同样,LS术后的主要并发症(LS:9.7%;CS:16.2%;HS:12.7%)最少。多变量分析证实,吻合技术是AL、总并发症和主要并发症的预测因素。在 miDG 中,AL 率(BI:1.4%,BII:0.8%,RX:1.2%)、总发病率(BI:14.5%,BII:15.0%,RX:18.7%)和主要发病率(BI:7.9%,BII:9.1%,RX:7.2%)以及死亡率(BI:0%,BII:0.1%,RY:1.1%%)均不受肠道重建的影响:结论:在肿瘤学条件合适的情况下,miDG应优于miTG,因为术后发病率明显降低。在西方中心,LS 应是 miTG 的首选吻合技术。相反,DG肠道重建可根据外科医生的偏好进行选择。
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来源期刊
Annals of surgery
Annals of surgery 医学-外科
CiteScore
14.40
自引率
4.40%
发文量
687
审稿时长
4 months
期刊介绍: The Annals of Surgery is a renowned surgery journal, recognized globally for its extensive scholarly references. It serves as a valuable resource for the international medical community by disseminating knowledge regarding important developments in surgical science and practice. Surgeons regularly turn to the Annals of Surgery to stay updated on innovative practices and techniques. The journal also offers special editorial features such as "Advances in Surgical Technique," offering timely coverage of ongoing clinical issues. Additionally, the journal publishes monthly review articles that address the latest concerns in surgical practice.
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