Safety and efficacy of post-anastomotic intraoperative endoscopy to avoid early anastomotic complications during gastrectomy for gastric cancer
Safety and efficacy of post-anastomotic intraoperative endoscopy to avoid early anastomotic complications during gastrectomy for gastric cancer
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DOI：
10.1007/s00464-019-07319-3
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发表时间：
2019-12-13
影响因子：
3.1
通讯作者：
Hong, Soon-Chan
中科院分区：
文献类型：
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作者：
Park, Ji-Ho;Jeong, Sang-Ho;Hong, Soon-Chan
背景 吻合口并发症如渗漏、出血和狭窄仍然是胃癌手术最严重的并发症。不存在准确可靠地预防这些并发症的完美方法。本研究调查了吻合后术中内窥镜检查（PAIOE）的安全性和有效性，以避免胃癌胃切除术期间早期吻合并发症。方法 这项回顾性病例对照研究招募了来自三级医疗、学术医疗中心的患者。 2015年至2016年间，对319名因胃癌接受胃切除术的患者进行了常规PAIOE。作为对照，将2013年至2014年期间的270名未接受PAIOE的患者用于比较。确定 PAIOE 后的早期吻合并发症和结果。结果 尽管PAIOE组与非PAIOE组总体并发症发生率无差异（20.1% vs 26.7%，P > 0.05），但PAIOE组吻合相关并发症较少（3.4% vs 8.9%，P < 0.01）。 PAIOE组的吻合口瘘发生率为2.5%，管腔内出血发生率为0.9%，吻合口狭窄发生率为0%，而非PAIOE组的发生率分别为5.6%、2.6%和0.7%。 26 例 PAIOE 患者（9.71%）检测到 31 项异常（静脉出血 20 例，粘膜撕裂 7 例，漏气 2 例，动脉出血 1 例，吻合口狭窄 1 例）。所有异常均通过适当的干预措施得到纠正（13 例加固额外缝合、13 例内镜下止血和 2 例重新吻合）。没有与 PAIOE 相关的并发症。结论 PAIOE 是评估胃癌患者胃肠吻合稳定性的安全可靠的方法。需要进一步的数据收集和精心设计的前瞻性研究来证实 PAIOE 的有效性。
Background Anastomotic complications such as leaks, bleeding, and stricture remain the most serious complications of surgery for gastric cancer. No perfect method exists for an accurate and reliable prevention of these complications. This study investigated the safety and efficacy of post-anastomotic intraoperative endoscopy (PAIOE) for avoidance of early anastomotic complications during gastrectomy in gastric cancer. Methods This retrospective case-control study enrolled patients from atertiary care, academic medical center. Routine PAIOE was performed on 319 patients undergoing gastrectomy for gastric cancer between 2015 and 2016. As controls, without PAIOE 270 patients from 2013 to 2014 were used for comparison. Early anastomotic complications and outcomes after PAIOE were determined. Results Although there were no differences between the PAIOE and non-PAIOE group in terms of overall complication rates (20.1% vs 26.7%;P > 0.05), there were fewer complications related to anastomosis (3.4% vs 8.9%;P < 0.01) in the PAIOE group. The PAIOE group had rates of 2.5% for anastomotic leakage, 0.9% for intra-luminal bleeding, and 0% for anastomotic stenosis, while the non-PAIOE group exhibited rates of 5.6%, 2.6%, and 0.7%, respectively. Thirty-one abnormalities were detected in 26 PAIOE patients (9.71%) (20 venous bleeding, 7 mucosal tearing, 2 air leaks, 1 arterial bleeding, and 1 anastomotic stricture). All abnormalities were corrected by proper interventions (13 reinforced additional suture, 13 endoscopic hemostasis, and 2 re-anastomosis). There were no morbidities associated with PAIOE. Conclusions PAIOE appears to be a safe and reliable procedure to evaluate the stability of gastrointestinal anastomosis for gastric cancer patients. Further data collection and a well-designed prospective study are needed to confirm the validity of PAIOE.