Intra-abdominal infection after radical gastrectomy for gastric cancer: Incidence, pathogens, risk factors and outcomes

J Cancer Res Clin Oncol

Pan

et al. 2018

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PurposeAllogeneic blood transfusions (BTF) are sometimes inevitable during radical gastrectomy with lymphadenectomy for advanced gastric cancer. The aim of this retrospective study was to investigate the association between BTF and post-operative infections, focusing on the impact of timing, amount of transfusion and the role of leukocyte depletion.MethodsThe study cohort was 2064 patients who underwent gastrectomy for gastric cancer from November 2010 to August 2017. The association between BTF and post-operative infections was estimated by univariate and multivariate analyses after propensity score matching. Subgroup analysis was performed according to the timing and amount of transfusion, and leukocyte depletion or not.ResultsOut of a total 2064 patients, 426 (20.6%) received peri-operative BTF. After one-to-one matching, 361 pairs of patients were included for further analysis, of who 68 (9.4%) developed infections. Multivariate analysis identified that an operation time ≥ 240 min, combined multi-organ resection, BTF and BMI ≥ 25 kg/m2 were independent risk factors for post-operative infection. Patients given a high-volume (> 7.5 U), intra-operatively of leukocyte-non-depleted BTF had the highest risk of developing infections clarified by subgroup analysis.ConclusionInfection was the most common complication following gastrectomy for gastric cancer and BTF was identified as an independent risk factor by propensity score matching and multivariate analyses. The timing, amount of transfusion and leukocyte depletion had an impact on the incidence of infection. To decrease infection, BTF should be avoided where possible, particularly during operation, with a large amount and leukocyte-not-depleted blood.

Section: Discussionsupporting

confidence: 88%

Section: Methodsmentioning

confidence: 99%

Impact of peri-operative blood transfusion on post-operative infections after radical gastrectomy for gastric cancer: a propensity score matching analysis focusing on the timing, amount of transfusion and role of leukocyte depletion

J Cancer Res Clin Oncol

Pan

et al. 2018

Self Cite

“…3 The main surgical procedures and peri-operative managements have been described in our previous study. 18 , 19 Briefly, open procedure with D2 or D2+ lymph node dissection was the main surgical type for patients with advanced GC. Combined multi-organ resection was carried out in patients with advanced tumors suspected of invading adjacent organs or to ease dissection of lymph nodes for the purpose of R0 resection.…”

Section: Methodsmentioning

confidence: 99%

Peri-Operative Blood Transfusion Does Not Influence Overall and Disease-Free Survival After Radical Gastrectomy for Stage II/III Gastric Cancer: a Propensity Score Matching Analysis

Journal of Gastrointestinal Surgery

et al. 2018

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ObjectiveWhether peri-operative blood transfusions (BTF) negatively impact long-term survival after gastrectomy for gastric cancer (GC) remains controversial. The aim of this retrospective study was to investigate independent predictive factors of BTF and the potential impact of BTF on overall survival (OS) and disease-free survival (DFS) in patients who underwent radical gastrectomy for stage II/III GC.MethodsOf 1020 patients who underwent gastrectomy for stage II/III GC from November 2010 to December 2015, 231 (22.6%) patients received BTF. The independent predictive factors of BTF were identified using univariate and multivariate analyses. Cox regression and propensity score matching (PSM) analyses of OS and DFS in patients who received BTF or not were compared.ResultsMultivariate analysis revealed that age, pre-operative hemoglobin levels, tumor size, operation time, combined multi-organ resection, and intra-operative blood loss were independent predictive factors for BTF. PSM analysis created 205 pairs of patients. BTF was significantly associated with decreased OS (P = 0.025) and DFS (P = 0.034) in the entire cohort before PSM. After PSM, there was no longer a significant association between BTF and OS (P = 0.850) or DFS (P = 0.880). BTF was not identified as an independent risk factor for OS or DFS by multivariate Cox regression analysis.ConclusionsThe present study revealed that BTF did not influence OS and DFS after radical gastrectomy for stage II/III GC. Worse oncological outcomes were caused by clinical circumstances requiring blood transfusions, including longer operation time and advanced tumor stage, not due to BTF itself.Electronic supplementary materialThe online version of this article (10.1007/s11605-018-3808-8) contains supplementary material, which is available to authorized users.

“…As reported in our previous studies, combined multi-organ resection (such as splenectomy and distal pancreatectomy) for locally advanced gastric cancer was positively associated with overall morbidity and intra-abdominal infection, which may increase the possibility of reoperation [ 17 - 18 ]. In a systematic review summarized by Brar et al [ 20 ] of 1,343 patients who underwent combined multi-organ resection, morbidity ranged from 11.8% to 90.5% and mortality was found to be 0-15%, which was significantly higher than in patients who underwent gastrectomy only.…”

Section: Discussionmentioning

confidence: 99%

“…However, it was significantly lower than the 7.9-10% reported in Western countries [ 4 , 9 ], where patients generally are heavier. Moreover, overweight patients with a BMI ≥ 25 kg/m 2 have been shown to be at a greater risk of suffering postoperative complications, with overweight being identified as an independent risk factor for reoperation following laparoscopic gastrectomy [ 8 , 16 - 18 ].…”

Section: Discussionmentioning

confidence: 99%

Incidence, Causes and Risk Factors for 30-Day Unplanned Reoperation After Gastrectomy for Gastric Cancer: Experience of a High-Volume Center

Wang

et al. 2018

Gastroenterol Res

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BackgroundTo investigate the incidence, causes and risk factors for unplanned reoperation because of early complications within 30 days of radical gastrectomy for gastric cancer.MethodsThe study cohort comprised 1,948 patients who underwent radical gastrectomy for gastric cancer between November 2010 and April 2017. The incidence, causes and outcomes of unplanned reoperation were examined and the risk factors were identified using univariate and multivariate analyses.ResultsIn total, 24 patients (1.2%) underwent unplanned reoperations because of early complications after radical gastrectomy. The main causes more frequently requiring reoperation were adhesive intestinal obstruction (eight cases, 33.3%), intra-abdominal bleeding (five cases, 20.8%), wound dehiscence (five cases, 20.8%), anastomotic leakage and intra-abdominal infection (five cases, 20.8%), and iatrogenic common bile duct injury (one case). Multivariate analysis identified that only combined multi-organ resection (odds ratio (OR) = 4.060, 95% confidence interval (CI): 1.645 - 10.023, P = 0.002) was an independent risk factor. Two patients (8.3%) who underwent reoperation died from disseminated intravascular coagulation or sepsis, respectively, which was significantly higher than the remaining 1,924 patients who did not require reoperation (six cases, 0.3%, P < 0.001). Moreover, patients who underwent reoperation experienced higher morbidity rates (37.5% vs. 6.8%, P < 0.001), requiring intensive care (20.8% vs. 2.4%, P < 0.001) and longer postoperative hospital stays (33.6 days vs. 11.0 days, P < 0.001) compared with patients required no reoperation.ConclusionsCombined multi-organ resection was an independent risk factor for unplanned reoperation following radical gastrectomy. Avoiding multi-organ resection as possible will decrease the likelihood of patients requiring reoperation.