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      Unplanned reoperation after radical gastrectomy for gastric cancer: causes, risk factors, and long-term prognostic influence

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          Abstract

          Purpose

          Unplanned reoperation (URO) after radical gastrectomy for gastric cancer (GC) mostly results from serious postoperative complications. At present, there is still controversy over the predictive factors for URO. Our goal was to identify the risk factors for URO and to investigate its potential impact on long-term survival.

          Patients and methods

          We included 2,852 GC patients who underwent a gastrectomy. Multivariate logistic regression analyses were performed to determine the risk factors for URO. Patients were randomly selected from the non-URO group by 1:4 propensity score matching with multiple parameters with patients from the URO group. The survival disparity of 34 URO patients and 136 non-URO patients was examined using the Kaplan–Meier method and the multivariate Cox proportional hazard model.

          Results

          The incidence of URO was 1.4% (39/2, 852). The primary cause of URO was intra-abdominal bleeding (53.9%, 21/39). Multivariate logistic regression analyses revealed that male gender (OR = 4.630, 95% CI = 1.412–15.152, P = 0.011), diabetes (OR = 4.189, 95% CI = 1.705–10.290, P = 0.002), and preoperative hypoproteinemia (OR = 2.305, 95% CI = 1.079–4.923, P = 0.031) were independent risk factors for URO. With regard to early surgical outcomes, patients undergoing URO had a longer hospital stay ( P < 0.001), higher incidence of postoperative complications ( P < 0.001), and greater mortality ( P < 0.001) compared with the non-URO group. No significant correlation was found between URO and cancer-specific survival in univariate ( P = 0.275) and multivariate ( P = 0.090) survival analyses.

          Conclusion

          Male gender, diabetes, and preoperative hypoproteinemia were suggested as independent risk factors for URO. URO was associated with longer hospital stay and increased perioperative mortality, but might not be correlated with long-term mortality.

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          Most cited references 28

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          Incidence and mortality of gastric cancer in China.

           Li-ling Yang (2006)
          Gastric cancer is one of the most frequent cancers in the world; almost two-thirds of gastric cancer cases and deaths occur in less developed regions. In China, based on two national mortality surveys conducted in 1970s and 1990s, there is an obvious clustering of geographical distribution of gastric cancer in the country, with the high mortality being mostly located in rural areas, especially in Gansu, Henan, Hebei, Shanxi and Shaanxi Provinces in the middle-western part of China. Despite a slight increase from the 1970s to early 1990s, remarkable declines in gastric cancer mortality were noticed in almost the entire population during the last decade in China. These declines were largely due to the dramatic improvements in the social-economic environment, lifestyle, nutrition, education and health care system after economic reforms started two decades ago. Nevertheless, gastric cancer will remain a significant cancer burden currently and be one of the key issues in cancer prevention and control strategy in China. It was predicted that, in 2005, 0.3 million deaths and 0.4 million new cases from gastric cancer would rank the third most common cancer. The essential package of the prevention and control strategy for gastric cancer in China would focus on controlling Helicobacter pylori (H. pylori) infection, improving educational levels, advocating healthy diet and anti-tobacco campaign, searching for cost-effective early detection, diagnosis and treatment programs including approaches for curable management and palliative care.
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            Exclusion of Kaposi Sarcoma From Analysis of Cancer Burden—Reply

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              Complications requiring reoperation after gastrectomy for gastric cancer: 17 years experience in a single institute.

               S. H. Oh,  S Noh,  Woo Hyung (2009)
              Morbidity and mortality rates following gastric cancer surgery are still high. The present study documented complications requiring reoperation after gastrectomy for gastric cancer and described surgical management for each complication. Between 1987 and 2004, 8,033 patients underwent gastrectomy at the Department of Surgery, College of Medicine, Yonsei University, and the records were reviewed. The most frequent complication was intestinal obstruction (88 patients, 54.3%), followed by intraabdominal bleeding (15, 9.3%), wound dehiscence or evisceration (15, 9.3%), incisional hernia (15, 9.3%), anastomotic leakage (seven, 4.2%), acalculous cholecystitis (five, 3.1%), duodenal stump leakage (five, 3.1%), intraabdominal abscess without leakage (five, 3.1%), bowel perforation (five, 3.1%), bile peritonitis due to hepatic duct injury (one, 0.6%), and biliary stricture (one, 0.6%). There were ten cases of hospital mortality (6.2%) from intraabdominal bleeding (four patients), intestinal obstruction (four patients), and anastomotic leakage (two patients). The most common long-term complication requiring reoperation was intestinal obstruction (69, 75.8%) due to adhesive formation rather than technical failure, while short-term complications were surgery-related and associated with high hospital mortality (14.1%). Proper preoperative preparation and faultless surgical skills are required during initial surgery to reduce complications and the need for reoperation.
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                Author and article information

                Journal
                Ther Clin Risk Manag
                Ther Clin Risk Manag
                Therapeutics and Clinical Risk Management
                Therapeutics and Clinical Risk Management
                Dove Medical Press
                1176-6336
                1178-203X
                2018
                28 May 2018
                : 14
                : 965-972
                Affiliations
                [1 ]Department of Gastrointestinal Surgery, The First Affiliated Hospital, Yijishan Hospital of Wannan Medical College, Wuhu, China
                [2 ]Department of Oncology, The First Affiliated Hospital, Yijishan Hospital of Wannan Medical College, Wuhu, China
                [3 ]Hepatobiliary Center, The First Affiliated Hospital of Nanjing Medical University, Key Laboratory of Liver Transplantation, Chinese Academy of Medical Sciences, Nanjing, China
                [4 ]Department of General Surgery, Qingyang County People’s Hospital, Qingyang, China
                Author notes
                Correspondence: Jinguo Wang, Department of Gastrointestinal Surgery, The First Affiliated Hospital, Yijishan Hospital of Wannan Medical College, 2 Zheshan West Road, Wuhu 241000, China, Tel +86 553 573 9558, Fax +86 553 573 8279, Email wangjgwnmc@ 123456126.com
                [*]

                These authors contributed equally to this work

                Article
                tcrm-14-965
                10.2147/TCRM.S164929
                5978462
                © 2018 Zuo et al. This work is published and licensed by Dove Medical Press Limited

                The full terms of this license are available at https://www.dovepress.com/terms.php and incorporate the Creative Commons Attribution – Non Commercial (unported, v3.0) License ( http://creativecommons.org/licenses/by-nc/3.0/). By accessing the work you hereby accept the Terms. Non-commercial uses of the work are permitted without any further permission from Dove Medical Press Limited, provided the work is properly attributed.

                Categories
                Original Research

                Medicine

                postoperative complications, reoperation, gastrectomy, stomach neoplasm

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