Factors Affecting Morbidity, Mortality, and Survival in Patients Undergoing Ivor Lewis Esophagogastrectomy

Karl, Richard C.; Schreiber, Robert; Boulware, David; Baker, Scott; Coppola, Domenico

doi:10.1097/00000658-200005000-00003

Cited by 273 publications

(185 citation statements)

References 35 publications

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“…In general, the global, clinical judgement seems to localize a subset of patients at risk for developing complications in general, whereas many patients with no risk factors at all may develop anastomotic leakage [12]. The risk factors for anastomotic leakage identified by univariate and multivariate analysis in our study corroborate with those found in other studies [1][2][3][4][5][6][7][8]. Similar to these studies, the number of risk factors present in an individual patient appeared to be an important predictor of anastomotic leakage in all anastomoses.…”

Section: Discussionsupporting

confidence: 88%

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Surgeons lack predictive accuracy for anastomotic leakage in gastrointestinal surgery

Karliczek

Harlaar

Zeebregts

et al. 2009

Int J Colorectal Dis

392

239

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Background The dramatic clinical consequences of anastomotic leakage in gastrointestinal surgery can be reduced by a diverting stoma or drainage of the peri-anastomotic area. Currently, the surgeons' clinical judgement is of major importance in decision making, but reliable data of the diagnostic accuracy are lacking. In this prospective clinical study, the surgeons' predictive accuracy for anastomotic leakage was evaluated. Materials and methods In 191 patients undergoing colorectal resection with anastomosis, the risk for anastomotic leakage was determined by the surgeon on the basis of a visual analogue scale (VAS). This risk assessment was compared to the actual occurrence of anastomotic leakage post-operatively. Results A total of 26 (13.6%) patients showed anastomotic leakage. The surgeons' median predicted leakage rate was 7.1% in anastomoses >15 cm from the anal verge and 9.5% ≤15 cm (sensitivity 38/62%, specificity 46/52%). Diagnostic accuracy was not influenced by the surgeons' training level (VAS score, surgeons 7.8% vs assistant surgeons 8.5%, p=0.96, sensitivity 41% vs 44%, specificity 59% vs 48%, p=0.20). Conclusion The surgeons' clinical risk assessment appeared to have a low predictive value for anastomotic leakage in gastrointestinal surgery. The low a priori risk of anastomotic leakage of 14% resulted in a low post-test odds (11%) of correct prediction of anastomotic leakage. This warrants the ongoing search for a better diagnostic test of anastomotic leakage to prevent morbidity and mortality.

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Section: Discussionsupporting

confidence: 88%

“…Clinically relevant anastomotic leakage rates range between 3% and 19% [1,[3][4][5][6][7][8][9]. Anastomotic leakage may remain localized, causing perianastomotic inflammation or abscess formation, or may progress to generalised peritonitis.…”

Section: Introductionmentioning

confidence: 99%

Surgeons lack predictive accuracy for anastomotic leakage in gastrointestinal surgery

Karliczek

Harlaar

Zeebregts

et al. 2009

Int J Colorectal Dis

392

239

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“…Pancreaticoduodenectomy for pancreatic cancer or radical oesophagectomy for oesophageal cancer are more surgically aggressive procedures than D2 gastrectomy and are recommended to be performed exclusively in specialised centres. They do not carry a risk of hospital mortality of over 10% in such centres (Altorki and Skinner, 1997;Gordon et al, 1998;Bottger and Junginger, 1999;Lerut et al, 1999;Tsiotos et al, 1999;Gouma et al, 2000;Karl et al, 2000). Postoperative mortality of over 10% is no longer acceptable in any kind of cancer surgery.…”

Section: Survival Of Igcsg D2 Gastrectomy Phase II Study M Degiuli Et Almentioning

confidence: 99%

Survival results of a multicentre phase II study to evaluate D2 gastrectomy for gastric cancer

Degiuli¹,

et al. 2004

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Curative resection is the treatment of choice for potentially curable gastric cancer. Two major Western studies in the 1990s failed to show a benefit from D2 dissection. They showed extremely high postoperative mortality after D2 dissection, and were criticised for the potential inadequacy of the pretrial training in the new technique of D2 dissection, prior to the phase III studies being initiated. The inclusion of pancreatectomy and splenectomy in D2 dissection was associated with increased morbidity and mortality. Following these results, we started a phase II trial to evaluate the safety and efficacy of pancreas-preserving D2 dissection. The results of this trial regarding the safety of pancreas preserving D2 dissection were published in 1998. In this paper, we present the survival results of this phase II trial to confirm the rationale of carrying out a phase III study comparing D1 vs D2 dissection for curable gastric cancer. Italian patients with histologically proven gastric adenocarcinoma were registered in the Italian Gastric Cancer Study Group Multicenter trial. The study was carried out based on the General Rules of the Japanese Research Society for Gastric Cancer. A strict quality control system was achieved by a supervising surgeon of the reference centre who had stayed at the National Cancer Center Hospital, Tokyo, to learn the standard D2 gastrectomy and the postoperative management. The standard procedure entailed removal of the first and second tier lymph nodes. During total gastrectomy, the pancreas was preserved according to the Maruyama technique. Complete follow-up was available to death or 5 years in 100% of patients and the median follow-up time was 4.38 years. Out of 297 consecutive patients registered, 191 patients were enrolled in the study between May 1994 and December 1996. The overall morbidity rate was 20.9%. The postoperative in-hospital mortality was 3.1%. The overall 5-year survival rate among all eligible patients was 55%. Survival was strictly related to stage, depth of wall invasion, lymph node involvement and type of gastrectomy (distal vs total). Our results suggest a survival benefit for pancreas-preserving D2 dissection in Italian patients with gastric cancer if performed in experienced centres. A phase III trial among exclusively experienced centres is urgently needed.

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“…Although it has been well established that one hour more of surgery time doubles the incidence of infection and it is certainly one more factor that increases trauma and its repercussions, operative time is still discussed. There is no relation between surgery duration and postoperative complications, death or long term survival 14 . Notwithstanding, it is also known that the longer the surgery takes, greater are the alterations that happen in body homeostasis during surgical trauma.…”

Section: Discussionmentioning

confidence: 98%

Ressecção endoscópica de nasoangiofibroma

Ferreira

Gomes

Azevedo

et al. 2006

Rev. Bras. Otorrinolaringol.

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O nasoangiofibroma é um tumor benigno com componente vascular que acomete homens jovens, e tem como principal tratamento a cirurgia. Tem sido descrita a utilização de cirurgia endoscópica para a ressecção de tumores em estádios iniciais, sem evidência de permanência de restos tumorais ou recidiva da doença. OBJETIVO: Este estudo tem o objetivo de avaliar a via endoscópica precedida pela embolização como meio de tratamento para nasoangiofibroma em estádios II, e um caso selecionado em estádio III, com avaliação da morbidade pós-operatória a partir das seguintes variáveis: tempo cirúrgico, tempo de internamento pós-operatório, necessidade de transfusão sangüínea, presença de complicações, tempo entre embolização e cirurgia e presença de recidiva tumoral. MATERIAIS E MÉTODOS: Foi realizado em estudo prospectivo, a partir de nove pacientes internados no Hospital Geral de Fortaleza SESA/SUS no período de outubro de 2001 a novembro de 2004. CONCLUSÃO: Pelos dados obtidos, concluiu-se que a via endoscópica, quando precedida pela embolização tumoral, é uma via eficaz no tratamento de nasoangiofibromas em estádios iniciais, com reduzida morbidade pós-operatória.

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Factors Affecting Morbidity, Mortality, and Survival in Patients Undergoing Ivor Lewis Esophagogastrectomy

Cited by 273 publications

References 35 publications

Surgeons lack predictive accuracy for anastomotic leakage in gastrointestinal surgery

Surgeons lack predictive accuracy for anastomotic leakage in gastrointestinal surgery

Survival results of a multicentre phase II study to evaluate D2 gastrectomy for gastric cancer

Ressecção endoscópica de nasoangiofibroma

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