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

Autor:	Schneider MA; Department of Surgery & Transplantation, University Hospital Zürich, Raemistrasse 100, 8091 Zurich, Switzerland., Kim J; Department of Surgery, Seoul National University Hospital, 101 Daehak-ro Jongno-gu, Seoul, South Korea., Berlth F; Department of General-, Visceral- and Transplant Surgery, University Medical Center Mainz, Langenbeckstraße 1, 55131 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, 3-8-31, Ariake, Koto-ku, Tokyo, 135-8550, Japan., Grimminger PP; Department of General-, Visceral- and Transplant Surgery, University Medical Center Mainz, Langenbeckstraße 1, 55131 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, United Kingdom., Butterworth W; Department of Upper GI Surgery, Queen Elizabeth Hospital, University Hospitals Birmingham NHS Foundation Trust, Birmingham, United Kingdom., Nienhüser H; Department of General, Visceral and Transplant Surgery, University Hospital Heidelberg, Im Neuenheimer Feld 420, 69120 Heidelberg, Germany., Müller B; Department of General, Visceral and Transplant Surgery, University Hospital Heidelberg, Im Neuenheimer Feld 420, 69120 Heidelberg, Germany., Crnovrsanin N; Department of General, Visceral and Transplant Surgery, University Hospital Heidelberg, Im Neuenheimer Feld 420, 69120 Heidelberg, Germany., Gero D; Department of Surgery & Transplantation, University Hospital Zürich, Raemistrasse 100, 8091 Zurich, Switzerland., Nickel F; Department of General, Visceral, and Thoracic Surgery, University Medical Center Hamburg-Eppendorf, Martinistrasse 52, 20251 Hamburg, Germany., Gisbertz S; Amsterdam UMC, Location University of Amsterdam, Department of Surgery, Meibergdreef 9, Amsterdam, The Netherlands & Cancer Center Amsterdam, Cancer Treatment and Quality of Life, Amsterdam, The Netherlands., van Berge Henegouwen MI; Amsterdam UMC, Location University of Amsterdam, Department of Surgery, Meibergdreef 9, Amsterdam, The Netherlands & Cancer Center Amsterdam, Cancer Treatment and Quality of Life, Amsterdam, The Netherlands., Pucher PH; Department of Surgery, Queen Alexandra Hospital, Portsmouth Hospitals NHS Trust, Portsmouth, United Kingdom., Khan K; Department of Surgery, Queen Alexandra Hospital, Portsmouth Hospitals NHS Trust, Portsmouth, United Kingdom., Chaudry A; The Royal Marsden NHS Foundation Trust, Chelsea, London, SW3 6JJ, United Kingdom., Patel PH; The Royal Marsden NHS Foundation Trust, Chelsea, London, SW3 6JJ, United Kingdom., Pera M; Section of Gastrointestinal Surgery, Hospital Universitario del Mar, Universitat Autònoma de Barcelona, Barcelona, Spain., Dal Cero M; Section of Gastrointestinal Surgery, Hospital Universitario del Mar, Universitat Autònoma de Barcelona, Barcelona, Spain., Garcia C; Hospital San Borja Arriarán, Av. Sta. Rosa 1234, Santiago, Región Metropolitana, Chile., Martinez Salinas G; Hospital San Borja Arriarán, Av. Sta. Rosa 1234, Santiago, Región Metropolitana, Chile., Kassab P; Gastroesophageal and Bariatric Surgical Division, Department of Surgery, Santa Casa of São Paulo Medical School and Hospital, São Paulo, Brazil., Prado Castro OA; Gastroesophageal and Bariatric Surgical Division, Department of Surgery, Santa Casa of São Paulo Medical School and Hospital, São Paulo, Brazil., Norero E; Esophagogastric Surgery Unit, Digestive Surgery Department, Hospital Dr Sotero del Rio, Pontificia Universidad Catolica de Chile, Santiago, Chile., Wisniowski P; Division of Upper GI and General Surgery, Keck School of Medicine, University of Southern California, 1510 San Pablo St., Health Sciences Campus, Los Angeles, USA., Putnam LR; Division of Upper GI and General Surgery, Keck School of Medicine, University of Southern California, 1510 San Pablo St., Health Sciences Campus, Los Angeles, USA., Lombardi PM; Division of Minimally Invasive Surgical Oncology, Niguarda Cancer Center, ASST Grande Ospedale Metropolitano Niguarda, Piazza Ospedale Maggiore, 3, 20162, Milan, Italy., Ferrari G; Division of Minimally Invasive Surgical Oncology, Niguarda Cancer Center, ASST Grande Ospedale Metropolitano Niguarda, Piazza Ospedale Maggiore, 3, 20162, Milan, Italy., Gudaityte R; Department of Surgery, Hospital of Lithuanian University of Health Sciences, Eiveniu 2, Kaunas 50161, Lithuania., Maleckas A; Department of Surgery, Hospital of Lithuanian University of Health Sciences, Eiveniu 2, Kaunas 50161, Lithuania., Prodehl L; Department of Surgery, Charlotte Maxeke Johannesburg Academic Hospital, University of the Witwatersrand, Johannesburg, South Africa., Castaldi A; Service de Chirurgie Digestive et Cancérologie Digestive, Hôpital Universitaire Carémeau, Nîmes, France., Prudhomme M; Service de Chirurgie Digestive et Cancérologie Digestive, Hôpital Universitaire Carémeau, Nîmes, France., Lee HJ; Department of Surgery, Seoul National University Hospital, 101 Daehak-ro Jongno-gu, Seoul, South Korea., Sano T; Department of Gastroenterological Surgery, Cancer Institute Hospital of the Japanese Foundation for Cancer Research, 3-8-31, Ariake, Koto-ku, Tokyo, 135-8550, Japan., Baiocchi GL; Department of Surgery, University Hospital of Brescia, Brescia, Italy., De Manzoni G; Department of Surgery, University Hospital of Verona, Verona, Italy., Giacopuzzi S; Department of Surgery, University Hospital of Verona, Verona, Italy., Bencivenga M; Department of Surgery, University Hospital of Verona, Verona, Italy., Rosati R; IRCCS San Raffaele Scientific Institute, Milano, Italy., Puccetti F; IRCCS San Raffaele Scientific Institute, Milano, Italy., D'Ugo D; FONDAZIONE POLICLINICO UNIVERSITARIO GEMELLI-IRCCS, Roma, Italy., Nunobe S; Department of Gastroenterological Surgery, Cancer Institute Hospital of the Japanese Foundation for Cancer Research, 3-8-31, Ariake, Koto-ku, Tokyo, 135-8550, Japan., Yang HK; Department of Surgery, Seoul National University Hospital, 101 Daehak-ro Jongno-gu, Seoul, South Korea., Gutschow CA; Department of Surgery & Transplantation, University Hospital Zürich, Raemistrasse 100, 8091 Zurich, Switzerland.
Jazyk:	angličtina
Zdroj:	Annals of surgery [Ann Surg] 2024 Aug 05. 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 2017-2021 in 44 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); hand sewn (HS)), and three 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, 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%, HS: 12.7%) were lowest after LS. Multivariate analysis confirmed anastomotic technique as predictive factor for AL, overall and major complications. In miDG, AL rate (BI: 1.4%, BII 0.8%, RX 1.2%), overall (BI: 14.5%, BII: 15.0%, RX: 18.7%,) and major morbidity (BI: 7.9%, BII: 9.1%, RX: 7.2%), and mortality (BI: 0%, BII: 0.1%, RY: 1.1%%) were not affected by bowel reconstruction. Conclusion: 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 surgeon's preference. Competing Interests: Sources of Funding/Support/Conflicts of Interest: The authors declare no conflict of interest. No third-party financial funds or materials were accepted or necessary for execution of this research project. (Copyright © 2024 Wolters Kluwer Health, Inc. All rights reserved.)
Databáze:	MEDLINE
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