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Postoperative mortality and morbidity after D2 lymphadenectomy for gastric cancer:A retrospective cohort study

World Journal of Gastroenterology 2022年第3期28卷 381-398页

作者： Giuseppe Brisinda Maria Michela Chiarello Anna Crocco Neill James Adams Pietro Fransvea serafino Vanella Abdominal surgery Fondazione Policlinico Universitario A Gemelli IRCCSRome 00168Italy Department of Medical and surgical sciences UniversitàCattolica del Sacro CuoreRome 00168Italy General surgery Operative Unit Azienda Sanitaria Provinciale di CrotoneOspedale San Giovanni di DioCrotone 88900Italy Endocrine surgery Operative Unit Istituto Nazionale TumoriIRCCS Fondazione PascaleNapoli 80100Italy Health sciences Clinical Microbiology UnitMagna Grecia UniversityCatanzaro 88100Italy Department of Emergency surgery and Trauma Center Fondazione Policlinico Universitario A Gemelli IRCCSRome 00168Italy Department of General and Oncological surgery Azienda Ospedaliera San Giuseppe MoscatiAvellino 83100Italy

BACKGROUND surgery for gastric cancer is a complex procedure and lymphadenectomy is often *** mortality and morbidity after curative gastric cancer surgery is not *** To evaluate the factors determining mortality and morbidity in a population of patients undergoing R0 resection and D2 lymphadenectomy for gastric *** A retrospective analysis of clinical data and pathological characteristics(age,sex,primary site of the tumor,Lauren histotype,number of positive lymph nodes resected,number of negative lymph nodes resected,and depth of invasion as defined by the standard nomenclature)was conducted in patients with gastric *** each patient we calculated the kattan’s *** arbitrarily divided the study population of patients into two groups based on the nomogram score(s or≥100 points).Prespecified subgroups in these analyses were defined according to age(≤65 years or>65 years),and number of lymph nodes retrieved(≤35 lymph nodes or>35 lymph nodes).Uni-and multivariate analysis of clinical and pathological findings were performed to identify the factors affecting postoperative mortality and *** One-hundred and eighty-six patients underwent a curative R0 resection with D2 *** mortality rate was 3.8%(7 patients);a higher mortality rate was observed in patients aged>65 years(P=0.002)and in N+patients(P=0.04).Following univariate analysis,mortality was related to a kattan’s score≥100 points(P=0.04)and the presence of advanced gastric cancer(P=0.03).Morbidity rate was 21.0%(40 patients).surgical complications were observed in 17 patients(9.1%).A higher incidence of morbidity was observed in patients where more than 35 lymph nodes were harvested(P=0.0005).CONCLUsION Mortality and morbidity rate are higher in N+and advanced gastric cancer *** removal of more than 35 lymph nodes does not lead to an increase in mortality.

关键词： Gastric cancer Total gastrectomy subtotal gastrectomy Lymphadenectomy kattan’s nomogram Mortality Postoperative complications Postoperative pancreatic fistula Hemoperitoneum Anastomotic leakage

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