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

作　　者：Giuseppe Brisinda Maria Michela Chiarello Anna Crocco Neill James Adams Pietro Fransvea Serafino Vanella 

机构地区：[1]Abdominal Surgery,Fondazione Policlinico Universitario A Gemelli IRCCS,Rome 00168,Italy [2]Department of Medical and Surgical Sciences,UniversitàCattolica del Sacro Cuore,Rome 00168,Italy [3]General Surgery Operative Unit,Azienda Sanitaria Provinciale di Crotone,Ospedale San Giovanni di Dio,Crotone 88900,Italy [4]Endocrine Surgery Operative Unit,Istituto Nazionale Tumori,IRCCS Fondazione Pascale,Napoli 80100,Italy [5]Health Sciences,Clinical Microbiology Unit,Magna Grecia University,Catanzaro 88100,Italy [6]Department of Emergency Surgery and Trauma Center,Fondazione Policlinico Universitario A Gemelli IRCCS,Rome 00168,Italy [7]Department of General and Oncological Surgery,Azienda Ospedaliera San Giuseppe Moscati,Avellino 83100,Italy

出　　处：《World Journal of Gastroenterology》2022年第3期381-398,共18页世界胃肠病学杂志（英文版）

摘　　要：BACKGROUND Surgery for gastric cancer is a complex procedure and lymphadenectomy is often mandatory.Postoperative mortality and morbidity after curative gastric cancer surgery is not insignificant.AIM To evaluate the factors determining mortality and morbidity in a population of patients undergoing R0 resection and D2 lymphadenectomy for gastric cancer.METHODS 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 cancer.For each patient we calculated the Kattan’s score.We arbitrarily divided the study population of patients into two groups based on the nomogram score(<100 points 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 morbidity.RESULTS One-hundred and eighty-six patients underwent a curative R0 resection with D2 lymphadenectomy.Perioperative 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 patients.The 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 

分 类 号：R735.2[医药卫生—肿瘤]