Reconstruction Techniques and Associated Morbidity in Minimally Invasive Gastrectomy for Cancer: Insights From the GastroBenchmark and GASTRODATA databases.

Autor:	Schneider MA; Department of Surgery and Transplantation, University Hospital Zürich, Zurich, Switzerland., Kim J; Department of Surgery, Seoul National University Hospital, Seoul, South Korea., Berlth F; Department of General-, Visceral- and Transplant Surgery, University Medical Center Mainz, Mainz, Germany.; Department of Surgery, University Hospital Tuebingen, Tuebingen, Germany., Sugita Y; Department of Gastroenterological Surgery, Cancer Institute Hospital of the Japanese Foundation for Cancer Research, Tokyo, Japan., Grimminger PP; Department of General-, Visceral- and Transplant Surgery, University Medical Center Mainz, Mainz, Germany., Wijnhoven BPL; Department of Surgery, Erasmus University Medical Center, Rotterdam, The Netherlands., Overtoom H; Department of Surgery, Erasmus University Medical Center, Rotterdam, The Netherlands., Gockel I; Department of Visceral, Transplant, Thoracic and Vascular Surgery, University Hospital of Leipzig, Leipzig, Germany., Thieme R; Department of Visceral, Transplant, Thoracic and Vascular Surgery, University Hospital of Leipzig, Leipzig, Germany., Griffiths EA; Department of Upper GI Surgery, Queen Elizabeth Hospital, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK., Butterworth W; Department of Upper GI Surgery, Queen Elizabeth Hospital, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK., Nienhüser H; Department of General, Visceral and Transplant Surgery, University Hospital Heidelberg, Heidelberg, Germany., Müller B; Department of General, Visceral and Transplant Surgery, University Hospital Heidelberg, Heidelberg, Germany., Crnovrsanin N; Department of General, Visceral and Transplant Surgery, University Hospital Heidelberg, Heidelberg, Germany., Gero D; Department of Surgery and Transplantation, University Hospital Zürich, Zurich, Switzerland., Nickel F; Department of General, Visceral, and Thoracic Surgery, University Medical Center Hamburg-Eppendorf, Hamburg, Germany., Gisbertz S; Department of Surgery, Amsterdam UMC, Location University of Amsterdam, Amsterdam, The Netherlands.; Cancer Center Amsterdam, Cancer Treatment and Quality of Life, Amsterdam, The Netherlands., van Berge Henegouwen MI; Department of Surgery, Amsterdam UMC, Location University of Amsterdam, Amsterdam, The Netherlands.; Cancer Center Amsterdam, Cancer Treatment and Quality of Life, Amsterdam, The Netherlands., Pucher PH; Cancer Center Amsterdam, Cancer Treatment and Quality of Life, Amsterdam, The Netherlands., Khan K; Cancer Center Amsterdam, Cancer Treatment and Quality of Life, Amsterdam, The Netherlands., Chaudry A; Department of Surgery, Queen Alexandra Hospital, Portsmouth Hospitals NHS Trust, Portsmouth, UK., Patel PH; Department of Surgery, Queen Alexandra Hospital, Portsmouth Hospitals NHS Trust, Portsmouth, UK., Pera M; Gastrointestinal Unit, The Royal Marsden NHS Foundation Trust, Chelsea, London, UK., Dal Cero M; Gastrointestinal Unit, The Royal Marsden NHS Foundation Trust, Chelsea, London, UK., Garcia C; Section of Gastrointestinal Surgery, Hospital Universitario del Mar, Universitat Autònoma de Barcelona, Barcelona, Spain., Martinez Salinas G; Section of Gastrointestinal Surgery, Hospital Universitario del Mar, Universitat Autònoma de Barcelona, Barcelona, Spain., Kassab P; Department of Surgery, Hospital San Borja Arriarán, Santiago, Región Metropolitana, Chile., Prado Castro OA; Department of Surgery, Hospital San Borja Arriarán, Santiago, Región Metropolitana, Chile., Norero E; Department of Surgery, Gastroesophageal and Bariatric Surgical Division, Santa Casa of São Paulo Medical School and Hospital, São Paulo, Brazil., Wisniowski P; Esophagogastric Surgery Unit, Digestive Surgery Department, Hospital Dr Sotero del Rio, Pontificia Universidad Catolica de Chile, Santiago, Chile., Putnam LR; Esophagogastric Surgery Unit, Digestive Surgery Department, Hospital Dr Sotero del Rio, Pontificia Universidad Catolica de Chile, Santiago, Chile., Lombardi PM; Division of Upper GI and General Surgery, Keck School of Medicine, University of Southern California, Los Angeles, CA., Ferrari G; Division of Upper GI and General Surgery, Keck School of Medicine, University of Southern California, Los Angeles, CA., Gudaityte R; Division of Minimally Invasive Surgical Oncology, Niguarda Cancer Center, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy., Maleckas A; Division of Minimally Invasive Surgical Oncology, Niguarda Cancer Center, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy., Prodehl L; Department of Surgery, Hospital of Lithuanian University of Health Sciences, Kaunas, Lithuania., Castaldi A; Department of Surgery, Charlotte Maxeke Johannesburg Academic Hospital, University of the Witwatersrand, Johannesburg, South Africa., Prudhomme M; Department of Surgery, Charlotte Maxeke Johannesburg Academic Hospital, University of the Witwatersrand, Johannesburg, South Africa., Lee HJ; Department of Surgery, Seoul National University Hospital, Seoul, South Korea., Sano T; Department of Gastroenterological Surgery, Cancer Institute Hospital of the Japanese Foundation for Cancer Research, Tokyo, Japan., Baiocchi GL; Department of Digestive Surgery and Digestive Oncology, Carémeau University Hospital, Nîmes, France., De Manzoni G; Department of Surgery, University Hospital of Brescia, Brescia, Italy., Giacopuzzi S; Department of Surgery, University Hospital of Brescia, Brescia, Italy., Bencivenga M; Department of Surgery, University Hospital of Brescia, Brescia, Italy., Rosati R; Department of Surgery, University Hospital of Verona, Verona, Italy., Puccetti F; Department of Surgery, University Hospital of Verona, Verona, Italy., D'Ugo D; Department of Surgery, IRCCS San Raffaele Scientific Institute, Milano, Italy., Nunobe S; Department of Gastroenterological Surgery, Cancer Institute Hospital of the Japanese Foundation for Cancer Research, Tokyo, Japan., Yang HK; Department of Surgery, Seoul National University Hospital, Seoul, South Korea., Gutschow CA; Department of Surgery and Transplantation, University Hospital Zürich, Zurich, Switzerland.
Jazyk:	angličtina
Zdroj:	Annals of surgery [Ann Surg] 2024 Nov 01; Vol. 280 (5), pp. 788-798. Date of Electronic Publication: 2024 Aug 05.
DOI:	10.1097/SLA.0000000000006470
Abstrakt:	Objective/background: Various anastomotic and reconstruction techniques are used for minimally invasive total (miTG) and distal gastrectomy (miDG). Their effects on postoperative morbidity have not been extensively studied. Methods: MiTG and miDG patients were selected from 9356 oncological gastrectomies performed in 2017-2021 in 43 centers. Endpoints included anastomotic leakage (AL) rate and postoperative morbidity tested by multivariable analysis. Results: Three major anastomotic techniques [circular stapled (CS); linear stapled (LS); and hand sewn (HS)], and 3 major bowel reconstruction types [Roux (RX); Billroth I (BI); Billroth II (BII)] were identified in miTG (n=878) and miDG (n=3334). Postoperative complications, including AL (5.2% vs 1.1%), overall (28.7% vs 16.3%), and major morbidity (15.7% vs 8.2%), as well as 90-day mortality (1.6% vs 0.5%) were higher after miTG compared with miDG. After miTG, the AL rate was higher after CS (4.3%) and HS (7.9%) compared with LS (3.4%). Similarly, major complications (LS: 9.7%, CS: 16.2%, and HS: 12.7%) were lowest after LS. Multivariate analysis confirmed anastomotic technique as a predictive factor for AL, overall, and major complications. In miDG, AL rate (BI: 1.4%, BII 0.8%, and RX 1.2%), overall (BI: 14.5%, BII: 15.0%, and RX: 18.7%), and major morbidity (BI: 7.9%, BII: 9.1%, and RX: 7.2%), and mortality (BI: 0%, BII: 0.1%, and RY: 1.1%%) were not affected by bowel reconstruction. Conclusions: In oncologically suitable situations, miDG should be preferred to miTG, as postoperative morbidity is significantly lower. LS should be a preferred anastomotic technique for miTG in Western Centers. Conversely, bowel reconstruction in DG may be chosen according to the surgeon's preference. Competing Interests: The authors report no conflicts of interest. (Copyright © 2024 The Author(s). Published by Wolters Kluwer Health, Inc.)
Databáze:	MEDLINE
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