Factors associated with anastomotic leak following gastrectomy for gastric adenocarcinoma and its effect on long-term outcomes
Rakesh Shaganti1
, Sunil Kumar Godara1, Rajneesh Kumar Singh1, Rahul R1, Shagun Misra2, Shaleen Kumar2
1Department of Surgical Gastroenterology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, India
2Department of Radiotherapy, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, India
Abstract
Objective: Gastrectomy for cancer is a technically demanding surgery and anastomotic leak is an important complication of this surgery. This study aimed to identify the factors associated with anastomotic leak following gastrectomy in gastric cancer patients and its long-term effect on outcomes.
Material and Methods: This is an ambispective study of 181 patients who underwent curative gastrectomy for gastric adenocarcinoma over 13 years, at our institution. Groups with and without anastomotic leak were compared using the Mann-Whitney U test (continuous variables) and Chi-square test (categorical variables). A multivariable analysis was performed to determine the factors associated with anastomotic leak.
Results: Out of the 181 patients who underwent curative gastrectomy, 12 (6.6%) patients experienced anastomotic leak. A multivariable analysis revealed that younger age, presence of comorbidities, hypoalbuminemia, tumor location in the proximal stomach, type of reconstruction, and positive margin status were associating factors for anastomotic leak. During a median follow-up of 34 months (ranging from 12 to 130), it was observed that 25 (18.3%) patients developed anastomotic stenosis, but it was not related to anastomotic leak. The incidence of post-operative pulmonary complications, administration of adjuvant therapy, recurrence rates, and mortality due to anastomotic leak did not significantly change. Moreover, neoadjuvant therapy did not increase the incidence of anastomotic leaks.
Conclusion: Factors like younger age, presence of comorbidities, hypoalbuminemia, tumor location in the proximal stomach, type of reconstruction, and positive margin status were associated with increased risk of anastomotic leak, which needs further studies to validate the findings. Thus, preoperative optimization and resection with adequate margins may be of utmost importance in preventing anastomotic leaks.
Keywords: Gastric cancer, gastrectomy, anastomotic leak, long-term effect, gastrojejunostomy, esophagojejunostomy
Cite this article as: Shaganti R, Godara SK, Singh RK, R R, Misra S, Kumar S. Factors associated with anastomotic leak following gastrectomy for gastric adenocarcinoma and its effect on long-term outcomes. Turk J Surg 2024; 40 (2): 111- 118.
This study was obtained from Sanjay Gandhi Post Graduate Institute Medical Sciences of Ethics Committee (Decision no: 2023-93-MCh-EXP-52, Date: 22.06.2023).
Externally peer-reviewed.
Concept - RKS; Design - RKS, SR, RR; Supervision - RKS, SM, SK, RR; Data Collection and/or Processing - RKS, SKG, SR; Analysis and/or Interpretation - RKS, SKG, SR; Literature Search - SR; Writing Manuscript - SR, RKS; Critical Reviews - All of authors.
The authors have no conflicts of interest to declare.
The authors declared that this study has received no financial support.