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Baiocchi GL, Giacopuzzi S, Vittimberga G, De Pascale S, Pastorelli E, Gelmini R, Viganò J, Graziosi L, Vagliasindi A, Rosa F, Steccanella F, Demartini P, Reddavid R, Berselli M, Elmore U, Romario UF, Degiuli M, Morgagni P, Marrelli D, D'Ugo D, Rosati R, De Manzoni G. Clinical outcomes of patients with complicated post-operative course after gastrectomy for cancer: a GIRCG study using the GASTRODATA registry. Updates Surg 2023; 75:419-427. [PMID: 35788552 PMCID: PMC9852164 DOI: 10.1007/s13304-022-01318-1] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2022] [Accepted: 06/14/2022] [Indexed: 02/07/2023]
Abstract
Gastrectomy for gastric cancer is still performed in Western countries with high morbidity and mortality. Post-operative complications are frequent, and effective diagnosis and treatment of complications is crucial to lower the mortality rates. In 2015, a project was launched by the EGCA with the aim of building an agreement on list and definitions of post-operative complications specific for gastrectomy. In 2018, the platform www.gastrodata.org was launched for collecting cases by utilizing this new complication list. In the present paper, the Italian Research Group for Gastric Cancer endorsed a collection of complicated cases in the period 2015-2019, with the aim of investigating the clinical pictures, diagnostic modalities, and treatment approaches, as well as outcome measures of patients experiencing almost one post-operative complication. Fifteen centers across Italy provided 386 cases with a total of 538 complications (mean 1.4 complication/patient). The most frequent complications were non-surgical infections (gastrointestinal, pulmonary, and urinary) and anastomotic leaks, accounting for 29.2% and 17.3% of complicated patients, with a median Clavien-Dindo score of II and IIIB, respectively. Overall mortality of this series was 12.4%, while mortality of patients with anastomotic leak was 25.4%. The clinical presentation with systemic septic signs, the timing of diagnosis, and the hospital volume were the most relevant factors influencing outcome.
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Affiliation(s)
- Gian Luca Baiocchi
- Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy.
- UOC General Surgery, ASST Cremona, Cremona, Italy.
| | - Simone Giacopuzzi
- Department of Surgery, General and Upper G.I. Surgery Division, University of Verona, Verona, Italy
| | | | | | - Elisabetta Pastorelli
- Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy
| | - Roberta Gelmini
- Department of Oncological Surgery, University of Modena, Modena, Italy
| | - Jacopo Viganò
- General Surgery, Department of Surgery, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Luigina Graziosi
- General and Emergency Surgery, University of Perugia, Santa Maria della Misericordia Hospital, Perugia, Italy
| | - Alessio Vagliasindi
- UOC General and Emergency Surgery, SSD Emergency Surgery, S. Maria delle Croci Hospital, Ravenna, Italy
| | - Fausto Rosa
- Department of General Surgery, Fondazione Policlinico Gemelli, Rome, Italy
| | | | - Paolo Demartini
- General, Oncological and Minimally Invasive Surgery, Cà Granda-Niguarda Hospital, Milan, Italy
| | - Rossella Reddavid
- Department of Oncology, Digestive and Surgical Oncology, University of Torino, and San Luigi University Hospital, Orbassano, Italy
| | - Mattia Berselli
- General Surgery Unit, Department of Surgery, ASST Settelaghi, Varese, Italy
| | - Ugo Elmore
- Gastrointestinal Surgery, San Raffaele Hospital and San Raffaele Vita-Salute University, Milan, Italy
| | | | - Maurizio Degiuli
- Department of Oncology, Digestive and Surgical Oncology, University of Torino, and San Luigi University Hospital, Orbassano, Italy
| | - Paolo Morgagni
- GB Morgagni-L Pierantoni Surgical Department, Forlì, Italy
| | - Daniele Marrelli
- Department of Medicine, Surgery and Neurosciences, Unit of General Surgery and Surgical Oncology, University of Siena, Siena, Italy
| | - Domenico D'Ugo
- Department of General Surgery, Fondazione Policlinico Gemelli, Rome, Italy
| | - Riccardo Rosati
- Gastrointestinal Surgery, San Raffaele Hospital and San Raffaele Vita-Salute University, Milan, Italy
| | - Giovanni De Manzoni
- Department of Surgery, General and Upper G.I. Surgery Division, University of Verona, Verona, Italy
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Application of Laparoscopic Gastric Jejunum Uncut Roux-en-Y Anastomosis. Gastroenterol Res Pract 2022; 2022:9496271. [PMID: 35601237 PMCID: PMC9119775 DOI: 10.1155/2022/9496271] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/21/2021] [Accepted: 03/02/2022] [Indexed: 11/18/2022] Open
Abstract
Background Uncut Roux-en-Y gastrojejunostomy, recently developed in China, is useful in the treatment of distal gastric cancer. This study is aimed at comparing laparoscopic gastric jejunum uncut Roux-en-Y anastomosis with conventional anastomosis in the surgical treatment of distal gastric malignancy. Methods In this retrospective study, the clinical data of 178 patients and their follow-up records were analyzed. 112 cases (uncut group) were the observation group for stomach jejunum uncut Roux-en-Y anastomosis, the control group for the stomach, 66 cases (conventional group) were for jejunum Roux-en-Y anastomosis and Billroth I and Billroth II anastomosis. A comparison between the two groups was conducted based on the general situation of the patients, TNM stage, and one-year survival rate. Results There was no significant difference reported between the two groups in terms of the general situation and TNM stage. A comparison on postoperative complications between the two groups revealed that the postoperative bleeding was 0.9% and 6.1%, the bile reflux gastritis was 1.8% and 9.1%, the anastomotic leakage was 0.0% and 3.0%, the delayed gastric emptying was 0.9% and 7.6%, and the overall complications was at 3.6% and 25.8%, which was significantly lower in the observation group than in the control group, and the difference was statistically significant. Notably, there was no significant difference in 1-year survival rate between the two groups. Conclusion Laparoscopic gastric jejunal uncut Roux-en-Y anastomosis significantly reduces the risk of postoperative complications of the digestive tract. Its operation is easy and exhibits an effective curative effect.
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Baiocchi GL, Giacopuzzi S, Reim D, Piessen G, Costa PMD, Reynolds JV, Meyer HJ, Morgagni P, Gockel I, Santos LL, Jensen LS, Murphy T, D'Ugo D, Rosati R, Fumagalli Romario U, Degiuli M, Kielan W, Mönig S, Kołodziejczyk P, Polkowski W, Pera M, Schneider PM, Wijnhoven B, de Steur WO, Gisbertz SS, Hartgrink H, van Sandick JW, Botticini M, Hölscher AH, Allum W, De Manzoni G. Incidence and Grading of Complications After Gastrectomy for Cancer Using the GASTRODATA Registry: A European Retrospective Observational Study. Ann Surg 2020; 272:807-813. [PMID: 32925254 DOI: 10.1097/sla.0000000000004341] [Citation(s) in RCA: 50] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
OBJECTIVE Utilizing a standardized dataset based on a newly developed list of 27 univocally defined complications, this study analyzed data to assess the incidence and grading of complications and evaluate outcomes associated with gastrectomy for cancer in Europe. SUMMARY BACKGROUND DATA The absence of a standardized system for recording gastrectomy-associated complications makes it difficult to compare results from different hospitals and countries. METHODS Using a secure online platform (www.gastrodata.org), referral centers for gastric cancer in 11 European countries belonging to the Gastrectomy Complications Consensus Group recorded clinical, oncological, and surgical data, and outcome measures at hospital discharge and at 30 and 90 days postoperatively. This retrospective observational study included all consecutive resections over a 2-year period. RESULTS A total of 1349 gastrectomies performed between January 2017 and December 2018 were entered into the database. Neoadjuvant chemotherapy was administered to 577 patients (42.8%). Total (46.1%) and subtotal (46.4%) gastrectomy were the predominant resections. D2 or D2+ lymphadenectomy was performed in almost 80% of operations. The overall complications' incidence was 29.8%; 402 patients developed 625 complications, with the most frequent being nonsurgical infections (23%), anastomotic leak (9.8%), other postoperative abnormal fluid from drainage and/or abdominal collections (9.3%), pleural effusion (8.3%), postoperative bleeding (5.6%), and other major complications requiring invasive treatment (5.6%). The median Clavien-Dindo score and Comprehensive Complications Index were IIIa and 26.2, respectively. In-hospital, 30-day, and 90-day mortality were 3.2%, 3.6%, and 4.5%, respectively. CONCLUSIONS The use of a standardized platform to collect European data on perioperative complications revealed that gastrectomy for gastric cancer is still associated with heavy morbidity and mortality. Actions are needed to limit the incidence of, and to effectively treat, the most frequent and most lethal complications.
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Affiliation(s)
- Gian Luca Baiocchi
- Department of Clinical and Experimental Sciences, Surgical Clinic, University of Brescia, and 3rd Division of General Surgery, Spedali Civili di Brescia, Brescia, Italy
| | - Simone Giacopuzzi
- Department of Surgery, General and Upper G.I. Surgery Division, University of Verona, Verona, Italy
| | - Daniel Reim
- Surgical Department, Klinikum Rechts der Isar, Technical University Munich, Munich, Germany
| | - Guillaume Piessen
- Department of Digestive and Oncological Surgery, University Lille, and Claude Huriez University Hospital, Lille, France
| | - Paulo Matos da Costa
- Faculdade Medicina, Universidade Lisboa, and General Surgery Department, Hospital Garcia de Orta, Lisbon, Portugal
| | - John V Reynolds
- Department of Surgery, St. James's Hospital and Trinity College Dublin, Ireland
| | | | - Paolo Morgagni
- GB Morgagni-L Pierantoni Surgical Department, Forlì, Italy
| | - Ines Gockel
- Department of Visceral, Transplant, Thoracic and Vascular Surgery, University Hospital of Leipzig, Leipzig, Germany
| | - Lucio Lara Santos
- Experimental Pathology and Therapeutics Group and Surgical Oncology Department, Portuguese Institute of Oncology, Porto, Portugal
| | | | - Thomas Murphy
- Department of Surgery, Mercy University Hospital, Cork, Republic of Ireland
| | - Domenico D'Ugo
- Department of General Surgery, Fondazione Policlinico Gemelli, Rome, Italy
| | - Riccardo Rosati
- Department of Gastrointestinal Surgery, San Raffaele Hospital, Milan, Italy
| | | | - Maurizio Degiuli
- Department of Oncology, Head, Digestive and Surgical Oncology, Gonzaga University of Torino, and San Luigi University Hospital, Orbassano, Italy
| | - Wojciech Kielan
- 2nd Department of General and Oncological Surgery, Wroclaw Medical University, Wroclaw, Poland
| | - Stefan Mönig
- Division of Abdominal Surgery, University Hospital of Geneva, Geneva, Switzerland
| | | | - Wojciech Polkowski
- Department of Surgical Oncology, Medical University of Lublin, Lublin, Poland
| | - Manuel Pera
- Department of Surgery, Section of Gastrointestinal Surgery, Hospital Universitario del Mar, Universitat Autònoma de Barcelona, and Hospital Universitario del Mar Medical Research Institute (IMIM), Barcelona, Spain
| | - Paul M Schneider
- Center for Visceral, Thoracic and Specialized Tumor Surgery, Hirslanden Medical Center, Zurich, Switzerland
| | - Bas Wijnhoven
- Department of Surgery, Erasmus Medical Center, Rotterdam, The Netherlands
| | - Wobbe O de Steur
- Department of Surgery, Leiden University Medical Center, Leiden, The Netherlands
| | - Suzanne S Gisbertz
- Department of Surgery, University Medical Center, Amsterdam, The Netherlands
| | - Henk Hartgrink
- Department of Surgery, Leiden University Medical Center, Leiden, The Netherlands
| | - Johanna W van Sandick
- Department of Surgery, Netherlands Cancer Institute, and Antoni van Leeuwenhoek Hospital, Amsterdam, The Netherlands
| | | | - Arnulf H Hölscher
- Contilia Center for Esophageal Diseases, Elisabeth Hospital, Essen, Germany
| | - William Allum
- Department of Surgery, Royal Marsden NHS Foundation Trust, London, United Kingdom
| | - Giovanni De Manzoni
- Department of Surgery, General and Upper G.I. Surgery Division, University of Verona, Verona, Italy
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Gianotti L, Fumagalli Romario U, De Pascale S, Weindelmayer J, Mengardo V, Sandini M, Cossu A, Parise P, Rosati R, Bencini L, Coratti A, Colombo G, Galli F, Rausei S, Casella F, Sansonetti A, Maggioni D, Costanzi A, Bernasconi DP, De Manzoni G. Association Between Compliance to an Enhanced Recovery Protocol and Outcome After Elective Surgery for Gastric Cancer. Results from a Western Population-Based Prospective Multicenter Study. World J Surg 2019; 43:2490-2498. [PMID: 31240434 DOI: 10.1007/s00268-019-05068-x] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
BACKGROUND The association between compliance to an enhanced recovery protocol (ERAS) and outcome after surgery for gastric cancer has been poorly investigated, particularly in Western patients. The aim of the study was to evaluate whether the rate of adherence to the ERAS program was correlated with outcome and time of discharge. METHODS A prospective, observational, multicenter study was designed to be performed at Italian referral centers for gastric surgery. The protocol was discussed and approved by the Italian Research Group on Gastric Cancer. Twenty-three ERAS domains were applied. A multivariate logistic regression was used to assess the association between ERAS compliance and overall and major complication rates. The Poisson regression model (measured as mean ratios) was used to assess the association of ERAS compliance rate and length of stay (LOS). RESULTS Eight centers participated and 290 subjects with a median age of 73 years were enrolled. The overall rates of adherence to pre-, intra-, and postoperative ERAS items were 69.8%, 60.3%, and 82.5%, respectively. At the multivariate model, there was an association between overall rate of morbidity and an overall ERAS compliance rate greater than 70% (OR 0.413; 95% CI 0.235-0.7240; P 0.002). A similar association was found for major complications (OR 0.328; 95% CI 0.151-0.709; P 0.005). The Poisson regression showed that in patients with ERAS compliance rate >70%, LOS was reduced of approximately 20% (mean ratio 0.812; 95% CI 0.694-0.950; P 0.009). CONCLUSIONS These results suggest a moderate compliance to an ERAS program and a significant association between adherence and outcomes.
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Affiliation(s)
- Luca Gianotti
- Department of Surgery, School of Medicine and Surgery, San Gerardo Hospital, Milano - Bicocca University, Monza, Italy
| | | | | | | | - Valentina Mengardo
- General and Esophagogastric Surgery, University of Verona, Verona, Italy
| | - Marta Sandini
- Department of Surgery, School of Medicine and Surgery, San Gerardo Hospital, Milano - Bicocca University, Monza, Italy
| | - Andrea Cossu
- Digestive Surgery, San Raffaele Hospital, San Raffaele Vita e Salute University, Milan, Italy
| | - Paolo Parise
- Digestive Surgery, San Raffaele Hospital, San Raffaele Vita e Salute University, Milan, Italy
| | - Riccardo Rosati
- Digestive Surgery, San Raffaele Hospital, San Raffaele Vita e Salute University, Milan, Italy
| | - Lapo Bencini
- Oncologic and Robotic Surgery, Department of Oncology, Azienda Ospedaliero - Universitaria Careggi, Florence, Italy
| | - Andrea Coratti
- Oncologic and Robotic Surgery, Department of Oncology, Azienda Ospedaliero - Universitaria Careggi, Florence, Italy
| | - Giovanni Colombo
- Department of Surgery, School of Medicine and Surgery, San Gerardo Hospital, Milano - Bicocca University, Monza, Italy
| | | | - Stefano Rausei
- Department of Surgery, ASST Valle Olona, Gallarate, Italy
| | - Francesco Casella
- General Surgery, Vannini-Figlie di San Camillo Hospital, Rome, Italy
| | - Andrea Sansonetti
- General Surgery, Vannini-Figlie di San Camillo Hospital, Rome, Italy
| | - Dario Maggioni
- General Surgery 3, ASST-Monza, Desio Hospital, Desio, Italy
| | | | - Davide P Bernasconi
- Centre of Biostatistics for Clinical Epidemiology, School of Medicine and Surgery, Milano-Bicocca University, Monza, Italy
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Baiocchi GL, Giacopuzzi S, Marrelli D, Reim D, Piessen G, Matos da Costa P, Reynolds JV, Meyer HJ, Morgagni P, Gockel I, Lara Santos L, Jensen LS, Murphy T, Preston SR, Ter-Ovanesov M, Fumagalli Romario U, Degiuli M, Kielan W, Mönig S, Kołodziejczyk P, Polkowski W, Hardwick R, Pera M, Johansson J, Schneider PM, de Steur WO, Gisbertz SS, Hartgrink H, van Sandick JW, Portolani N, Hölscher AH, Botticini M, Roviello F, Mariette C, Allum W, De Manzoni G. International consensus on a complications list after gastrectomy for cancer. Gastric Cancer 2019; 22:172-189. [PMID: 29846827 DOI: 10.1007/s10120-018-0839-5] [Citation(s) in RCA: 83] [Impact Index Per Article: 13.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/15/2018] [Accepted: 05/19/2018] [Indexed: 02/07/2023]
Abstract
BACKGROUND Perioperative complications can affect outcomes after gastrectomy for cancer, with high mortality and morbidity rates ranging between 10 and 40%. The absence of a standardized system for recording complications generates wide variation in evaluating their impacts on outcomes and hinders proposals of quality-improvement projects. The aim of this study was to provide a list of defined gastrectomy complications approved through international consensus. METHODS The Gastrectomy Complications Consensus Group consists of 34 European gastric cancer experts who are members of the International Gastric Cancer Association. A group meeting established the work plan for study implementation through Delphi surveys. A consensus was reached regarding a set of standardized methods to define gastrectomy complications. RESULTS A standardized list of 27 defined complications (grouped into 3 intraoperative, 14 postoperative general, and 10 postoperative surgical complications) was created to provide a simple but accurate template for recording individual gastrectomy complications. A consensus was reached for both the list of complications that should be considered major adverse events after gastrectomy for cancer and their specific definitions. The study group also agreed that an assessment of each surgical case should be completed at patient discharge and 90 days postoperatively using a Complication Recording Sheet. CONCLUSION The list of defined complications (soon to be validated in an international multicenter study) and the ongoing development of an electronic datasheet app to record them provide the basic infrastructure to reach the ultimate goals of standardized international data collection, establishment of benchmark results, and fostering of quality-improvement projects.
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Affiliation(s)
- Gian Luca Baiocchi
- Department of Clinical and Experimental Sciences, Surgical Clinic, University of Brescia, Brescia, Italy.
- 3rd Division of General Surgery, Spedali Civili di Brescia, P.le Spedali Civili 1, 25127, Brescia, Italy.
| | - Simone Giacopuzzi
- Department of Surgery, General and Upper G.I. Surgery Division, University of Verona, Verona, Italy
| | - Daniele Marrelli
- Department of Medicine, Surgery and Neurosciences, Unit of General Surgery and Surgical Oncology, University of Siena, Siena, Italy
| | - Daniel Reim
- Surgical Department, Klinikum Rechts der Isar, Technical University Munich, Munich, Germany
| | - Guillaume Piessen
- Department of Digestive and Oncological Surgery, Univ. Lille, and Claude Huriez University Hospital, Lille, France
| | - Paulo Matos da Costa
- Faculdade Medicina, Universidade Lisboa, Lisbon, Portugal
- General Surgery Department, Hospital Garcia de Orta, Lisbon, Portugal
| | - John V Reynolds
- Department of Surgery, St. James's Hospital and Trinity College Dublin, Dublin, Ireland
| | | | - Paolo Morgagni
- GB Morgagni-L Pierantoni Surgical Department, Forlì, Italy
| | - Ines Gockel
- Department of Visceral, Transplant, Thoracic and Vascular Surgery, University Hospital of Leipzig, Leipzig, Germany
| | - Lucio Lara Santos
- Experimental Pathology and Therapeutics Group and Surgical Oncology Department, Portuguese Institute of Oncology, Porto, Portugal
| | | | - Thomas Murphy
- Department of Surgery, Mercy University Hospital, Cork City, Ireland
| | - Shaun R Preston
- Oesophageal Gastric Unit, Royal Surrey County Hospital NHS Foundation Trust, Guilford, UK
| | - Mikhail Ter-Ovanesov
- Oncological and Haematological RUPF, Moscow Municipal Oncological Hospital, Moscow, Russia
| | | | - Maurizio Degiuli
- Department of Oncology, Head, Digestive and Surgical Oncology, University of Torino, and San Luigi University Hospital, Orbassano, Italy
| | - Wojciech Kielan
- 2nd Department of General and Oncological Surgery, Wroclaw Medical University, Wrocław, Poland
| | - Stefan Mönig
- Division of Abdominal Surgery, University Hospital of Geneva, Geneva, Switzerland
| | | | - Wojciech Polkowski
- Department of Surgical Oncology, Medical University of Lublin, Lublin, Poland
| | | | - Manuel Pera
- Department of Surgery, Section of Gastrointestinal Surgery, Hospital Universitario del Mar, Universitat Autònoma de Barcelona, and Hospital Universitario del Mar Medical Research Institute (IMIM), Barcelona, Spain
| | - Jan Johansson
- Department of Clinical Sciences, Surgery, Faculty of Medicine, Lund University, Lund, Sweden
| | - Paul M Schneider
- Center for Visceral, Thoracic and Specialized Tumor Surgery, Hirslanden Medical Center, Zurich, Switzerland
| | - Wobbe O de Steur
- Department of Surgery, Leiden University Medical Center, Leiden, The Netherlands
| | - Suzanne S Gisbertz
- Department of Surgery, Academic Medical Center, Amsterdam, The Netherlands
| | - Henk Hartgrink
- Department of Surgery, Leiden University Medical Center, Leiden, The Netherlands
| | - Joanna W van Sandick
- Department of Surgery, Netherlands Cancer Institute, and Antoni van Leeuwenhoek Hospital, Amsterdam, The Netherlands
| | - Nazario Portolani
- Department of Clinical and Experimental Sciences, Surgical Clinic, University of Brescia, Brescia, Italy
- 3rd Division of General Surgery, Spedali Civili di Brescia, P.le Spedali Civili 1, 25127, Brescia, Italy
| | - Arnulf H Hölscher
- German Center for Esophageal and Gastric Surgery, Agaplesion Markuskrankenhaus, Frankfurt, Germany
| | | | - Franco Roviello
- Department of Medicine, Surgery and Neurosciences, Unit of General Surgery and Surgical Oncology, University of Siena, Siena, Italy
| | - Christophe Mariette
- Department of Digestive and Oncological Surgery, Univ. Lille, and Claude Huriez University Hospital, Lille, France
| | - William Allum
- Department of Surgery, Royal Marsden NHS Foundation Trust, London, UK
| | - Giovanni De Manzoni
- Department of Surgery, General and Upper G.I. Surgery Division, University of Verona, Verona, Italy
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Mengardo V, Cormack OM, Weindelmayer J, Chaudry A, Bencivenga M, Giacopuzzi S, Allum WH, de Manzoni G. Multicenter Study of Presentation, Management, and Postoperative and Long-Term Outcomes of Septegenerians and Octogenerians Undergoing Gastrectomy for Gastric Cancer. Ann Surg Oncol 2018; 25:2374-2382. [PMID: 29868974 DOI: 10.1245/s10434-018-6543-1] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2017] [Indexed: 01/10/2023]
Abstract
BACKGROUND The optimal treatment strategy for elderly patients with gastric cancer is still controversial. This study aimed to assess the impact of age on short- and long-term outcomes after treatment for primary gastric cancer. METHODS From January 2004 to December 2014, a total of 507 patients underwent gastrectomy for gastric adenocarcinoma at two high-volume upper gastrointestinal (GI) centers. The patients were classified into three groups as follows: group A (patients ≤ 69 years old, n = 266), group B (patients 70-79 years old, n = 166), and group C (patients ≥ 80 years old, n = 75). Clinicopathologic characteristics as well as, short- and long-term outcomes were compared between the groups. RESULTS The patients in groups B and C had more comorbidities, whereas the younger subjects (group A) had more advanced tumor stages. Less extensive surgery was performed in the groups B and C. Older patients (age ≥ 70 years) had more postoperative medical complications. Moreover, group C had a higher postoperative mortality rate (8.1%) than group A (1.8%) or group B (1.9%). In the multivariable analysis, age older than 80 years (group C) was a negative independent factor for overall survival (OS) (hazard ratio [HR], 2.36) compared with group A, whereas group B seemed to have a comparable risk (HR, 1.37). Notably, the three groups did not show significant differences in disease-related survival (DRS). CONCLUSION The data suggest that patients 70-79 years of age show a risk of postoperative death comparable with that of younger subjects. However, patients older than 80 years should be carefully selected for surgical treatment due to the increased risk of postoperative mortality.
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Affiliation(s)
- Valentina Mengardo
- General and Upper GI Surgery Division, University of Verona, Verona, Italy.
| | - Orla Mc Cormack
- Department of Upper Gastrointestinal Surgery, Royal Marsden Hospital, London, UK
| | | | - Asif Chaudry
- Department of Upper Gastrointestinal Surgery, Royal Marsden Hospital, London, UK
| | - Maria Bencivenga
- General and Upper GI Surgery Division, University of Verona, Verona, Italy
| | - Simone Giacopuzzi
- General and Upper GI Surgery Division, University of Verona, Verona, Italy
| | - William H Allum
- Department of Upper Gastrointestinal Surgery, Royal Marsden Hospital, London, UK
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7
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Fumagalli Romario U, Weindelmayer J, Coratti A, Cossu A, Gianotti L, Rausei S, Sansonetti A, De Pascale S. Enhanced recovery after surgery in gastric cancer: which are the main achievements from the Italian experience? Updates Surg 2018; 70:257-264. [PMID: 29633186 DOI: 10.1007/s13304-018-0522-8] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2017] [Accepted: 02/24/2018] [Indexed: 12/27/2022]
Abstract
In the last years, the concept of 'enhanced recovery after surgery' (ERAS) has become a routine in the perioperative care of patients undergoing colorectal resection. The application of ERAS programs in gastric surgery had a more difficult penetration into clinical practice, mainly for the introduction of radical changes in the traditional postoperative management. The aim of the study was to analyze the rate of compliance to a standardized ERAS protocol in different Italian centers and evaluate the results in terms of postoperative outcomes. From April 2015 to July 2017, a prospective observational study was conducted among seven centers participating in the Italian Group for Research for Gastric Cancer (GIRCG), in patient candidates to elective gastrectomy for cancer. A standardized ERAS perioperative protocol was approved by all centers. Compliance to the protocol was then evaluated and postoperative outcomes (morbidity and mortality rate, duration of hospital stay and readmission rate) were analyzed. Two-hundred and seventy unselected patients operated on for gastric cancer were enrolled. The median age was 73 years; 40.4% of patients were female; 24.1% had a nutritional risk score ≥ 3. Perioperative chemotherapy was used in 23.7% of cases. Total gastrectomy was performed in 57.4% of patients; minimally invasive approach was adopted in 28.1% of patients. Adherence to the protocol varied between 23 and 88% for single items. It was quite low for pre- and intraoperative items, mainly for items related to nutritional care. Postoperative complications occurred in 35.5% of patients, mortality was 0.7%. Median length of hospital stay was 8 days (range 4-72) and the readmission rate was 6.3%. There is a growing attention on the implementation of ERAS protocol for gastric cancer surgery, but several elements of this protocol are still not routinely adopted, among them items regarding nutritional care.
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Affiliation(s)
| | | | - Andrea Coratti
- Oncologic and Robotic Surgery, Department of Oncology, Azienda Ospedaliero-Universitaria Careggi, Florence, Italy
| | - Andrea Cossu
- Digestive Surgery, San Raffaele Hospital, San Raffaele Vita e Salute University, Milan, Italy
| | - Luca Gianotti
- Department of Surgery, San Gerardo Hospital, School of Medicine and Surgery, Milano-Bicocca University, Monza, Italy
| | | | - Andrea Sansonetti
- General Surgery, Vannini-Figlie di San Camillo Hospital, Rome, Italy
| | - Stefano De Pascale
- UO Chirurgia Generale 2, ASST Spedali Civili, Piazza Spedali Civili 1, 25123, Brescia, Italy
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