Individualized treatment of anastomotic leakage after laparoscopic D2 radical gastrectomy_CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Authors：

GONG Lei ¹ , YU Jing ¹ , LÜ Zhenbing ¹ , JIA Min ² , HUANG Bin ¹ , PU Min ¹ , TIAN Yunhong ¹ ,  REN Mingyang ¹

1. Department of Gastrointestinal Surgery, Nanchong Central Hospital, Nanchong, Sichuan 637000, P. R. China;
2. Department of Radiology, Nanchong Central Hospital, Nanchong, Sichuan 637000, P. R. China;

Corresponding author：

REN Mingyang, Email: 2861746489@qq.com

Keywords：

endoluminal covered stent; anastomotic leakage; stomach neoplasms; individualized treatment

DOI：

10.7507/1007-9424.201910047

Video：

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Objective To summarize the experience in the treatment of anastomotic leakage after laparoscopic D2 radical gastrectomy.Method The clinicopathologic data of 11 patients with anastomotic leakage after the laparoscopic D2 radical gastrectomy in the Nanchong Central Hospital from May 2016 to January 2018 were analyzed retrospectively.Results Among the 11 patients with anastomotic leakage, 3 were grade Ⅱ leakages and 8 were grade Ⅲa leakages. There were no symptoms in the 3 cases of anastomotic leakage, which were confirmed only by the gastrointestinal radiography and were healed after 7 d of conservative treatment. Among the 8 patients with the clinical symptoms, 5 cases were treated by the endoscopic drainage and negative pressure suction for 60–90 d, 3 cases were treated by the endoscopic covered stent, 2 cases were cured after 30–60 d, and 1 case died of massive bleeding after 45 d.Conclusions Due to differences of location, time, limitation, and size of anastomotic leakage after laparoscopic D2 radical gastrectomy, individualized treatment should be performed according to specific situation of patients in local treatment. Endoluminal covered stent has certain clinical application value.

Citation： GONG Lei, YU Jing, LÜ Zhenbing, JIA Min, HUANG Bin, PU Min, TIAN Yunhong, REN Mingyang. Individualized treatment of anastomotic leakage after laparoscopic D2 radical gastrectomy. CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY, 2020, 27(7): 831-835. doi: 10.7507/1007-9424.201910047 Copy

1.	Etoh T, Inomata M, Shiraishi N, et al. Revisional surgery after gastrectomy for gastric cancer: review of the literature. Surg Laparosc Endosc Percutan Tech, 2010, 20(5): 332-337.
2.	Kim YE, Lim JS, Hyung WJ, et al. Clinical implication of positive oral contrast computed tomography for the evaluation of postoperative leakage after gastrectomy for gastric cancer. J Comput Assist Tomogr, 2010, 34(4): 537-542.
3.	Upponi S, Ganeshan A, D’Costa H, et al. Radiological detection of post-oesophagectomy anastomotic leak—a comparison between multidetector CT and fluoroscopy. Br J Radiol, 2008, 81(967): 545-548.
4.	Roh S, Iannettoni MD, Keech JC, et al. Role of barium swallow in diagnosing clinically significant anastomotic leak following esophagectomy. Korean J Thorac Cardiovasc Surg, 2016, 49(2): 99-106.
5.	Katayama H, Kurokawa Y, Nakamura K, et al. Extended Clavien-Dindo classification of surgical complications: Japan Clinical Oncology Group postoperative complications criteria. Surg Today, 2016, 46(6): 668-685.
6.	Jiang N, Deng JY, Ding XW, et al. Effect of complication grade on survival following curative gastrectomy for carcinoma. World J Gastroenterol, 2014, 20(25): 8244-8252.
7.	Huang J, Zhou Y, Wang C, et al. Logistic regression analysis of the risk factors of anastomotic fistula after radical resection of esophageal-cardiac cancer. Thorac Cancer, 2017, 8(6): 666-671.
8.	Kikuchi H, Miyata H, Konno H, et al. Development and external validation of preoperative risk models for operative morbidities after total gastrectomy using a Japanese web-based nationwide registry. Gastric Cancer, 2017, 20(6): 987-997.
9.	Zuo X, Cai J, Chen Z, et al. Unplanned reoperation after radical gastrectomy for gastric cancer: causes, risk factors, and long-term prognostic influence. Ther Clin Risk Manag, 2018, 14: 965-972.
10.	Persson S, Rouvelas I, Kumagai K, et al. Treatment of esophageal anastomotic leakage with self-expanding metal stents: analysis of risk factors for treatment failure. Endosc Int Open, 2016, 4(4): E420-E426.
11.	Oh SJ, Choi WB, Song J, et al. Complications requiring reoperation after gastrectomy for gastric cancer: 17 years experience in a single institute. J Gastrointest Surg, 2009, 13(2): 239-245.
12.	Carboni F, Valle M, Federici O, et al. Esophagojejunal anastomosis leakage after total gastrectomy for esophagogastric junction adenocarcinoma: options of treatment. J Gastrointest Oncol, 2016, 7(4): 515-522.
13.	Portanova M. Successful enteral nutrition in the treatment of esophagojejunal fistula after total gastrectomy in gastric cancer patients. World J Surg Oncol, 2010, 8: 71.
14.	孙益红, 方勇. 胃癌根治术后吻合口相关并发症的发生原因及防治要点. 中华胃肠外科杂志, 2017, 20(2): 144-147.
15.	黄伟钊, 吴颖猛, 叶红雨, 等. 食管癌术后消化道瘘的个体化治疗. 中国胸心血管外科临床杂志, 2011, 18(5): 469-471.
16.	刘金钢, 孙威. 腹腔镜胃癌根治术后吻合口漏的诊断与治疗. 中华普外科手术学杂志(电子版), 2015, 9(2): 86-89.
17.	胡祥, 张驰. 日本和韩国胃癌术后并发症诊断及风险评价. 中华胃肠外科杂志, 2017, 20(2): 129-134.
18.	刘文韬, 燕敏. 胃癌根治术后吻合口瘘原因及处理. 中国实用外科杂志, 2013, 33(4): 284-286.
19.	藏潞, 胡伟国, 郑民华. 腹腔镜胃癌根治术并发症及其预防. 中华胃肠外科杂志, 2013, 16(10): 940-943.
20.	祝子逸, 郦志军, 何正富, 等. 内镜引导下吻合口瘘冲洗治疗食管胃吻合口瘘合并瘘旁脓肿临床疗效观察. 浙江大学学报(医学版), 2017, 46(6): 637-642.
21.	李树海, 岳韦名, 李林, 等. 胸腹腔镜联合食管癌切除术后颈部残胃闭锁端瘘的诊治经验. 中华胸部外科电子杂志, 2016, 3(1): 56-58.
22.	金新天, 李志军, 殷波. 食管、贲门癌根治术后胸内吻合口瘘的治疗探讨. 四川医学, 2007, 28(3): 294-296.
23.	Xu QY, Yin GW, Chen SX, et al. Fluoroscopically guided nose tube drainage of mediastinal abscesses in post-operative gastro-oesophageal anastomotic leakage. Br J Radiol, 2012, 85(1019): 1477-1481.
24.	Segalin A, Bonavina L, Lazzerini M, et al. Endoscopic management of inveterate esophageal perforations and leaks. Surg Endosc, 1996, 10(9): 928-932.
25.	Verstegen MHP, Bouwense SAW, van Workum F, et al. Management of intrathoracic and cervical anastomotic leakage after esophagectomy for esophageal cancer: a systematic review. World J Emerg Surg, 2019, 14: 17.
26.	van Rossum PSN, Haverkamp L, Carvello M, et al. Management and outcome of cervical versus intrathoracic manifestation of cervical anastomotic leakage after transthoracic esophagectomy for cancer. Dis Esophagus, 2017, 30(1): 1-8.
27.	Fumagalli U, Baiocchi GL, Celotti A, et al. Incidence and treatment of mediastinal leakage after esophagectomy: Insights from the multicenter study on mediastinal leaks. World J Gastroenterol, 2019, 25(3): 356-366.
28.	Leers JM, Vivaldi C, Schäfer H, et al. Endoscopic therapy for esophageal perforation or anastomotic leak with a self-expandable metallic stent. Surg Endosc, 2009, 23(10): 2258-2262.
29.	陈华栋, 黄益, 邱永, 等. 国产自膨式带膜支架治疗食管-胃吻合口瘘的疗效. 实用医学影像杂志, 2007, 8(2): 115-118.

1. Etoh T, Inomata M, Shiraishi N, et al. Revisional surgery after gastrectomy for gastric cancer: review of the literature. Surg Laparosc Endosc Percutan Tech, 2010, 20(5): 332-337.
2. Kim YE, Lim JS, Hyung WJ, et al. Clinical implication of positive oral contrast computed tomography for the evaluation of postoperative leakage after gastrectomy for gastric cancer. J Comput Assist Tomogr, 2010, 34(4): 537-542.
3. Upponi S, Ganeshan A, D’Costa H, et al. Radiological detection of post-oesophagectomy anastomotic leak—a comparison between multidetector CT and fluoroscopy. Br J Radiol, 2008, 81(967): 545-548.
4. Roh S, Iannettoni MD, Keech JC, et al. Role of barium swallow in diagnosing clinically significant anastomotic leak following esophagectomy. Korean J Thorac Cardiovasc Surg, 2016, 49(2): 99-106.
5. Katayama H, Kurokawa Y, Nakamura K, et al. Extended Clavien-Dindo classification of surgical complications: Japan Clinical Oncology Group postoperative complications criteria. Surg Today, 2016, 46(6): 668-685.
6. Jiang N, Deng JY, Ding XW, et al. Effect of complication grade on survival following curative gastrectomy for carcinoma. World J Gastroenterol, 2014, 20(25): 8244-8252.
7. Huang J, Zhou Y, Wang C, et al. Logistic regression analysis of the risk factors of anastomotic fistula after radical resection of esophageal-cardiac cancer. Thorac Cancer, 2017, 8(6): 666-671.
8. Kikuchi H, Miyata H, Konno H, et al. Development and external validation of preoperative risk models for operative morbidities after total gastrectomy using a Japanese web-based nationwide registry. Gastric Cancer, 2017, 20(6): 987-997.
9. Zuo X, Cai J, Chen Z, et al. Unplanned reoperation after radical gastrectomy for gastric cancer: causes, risk factors, and long-term prognostic influence. Ther Clin Risk Manag, 2018, 14: 965-972.
10. Persson S, Rouvelas I, Kumagai K, et al. Treatment of esophageal anastomotic leakage with self-expanding metal stents: analysis of risk factors for treatment failure. Endosc Int Open, 2016, 4(4): E420-E426.
11. Oh SJ, Choi WB, Song J, et al. Complications requiring reoperation after gastrectomy for gastric cancer: 17 years experience in a single institute. J Gastrointest Surg, 2009, 13(2): 239-245.
12. Carboni F, Valle M, Federici O, et al. Esophagojejunal anastomosis leakage after total gastrectomy for esophagogastric junction adenocarcinoma: options of treatment. J Gastrointest Oncol, 2016, 7(4): 515-522.
13. Portanova M. Successful enteral nutrition in the treatment of esophagojejunal fistula after total gastrectomy in gastric cancer patients. World J Surg Oncol, 2010, 8: 71.
14. 孙益红, 方勇. 胃癌根治术后吻合口相关并发症的发生原因及防治要点. 中华胃肠外科杂志, 2017, 20(2): 144-147.
15. 黄伟钊, 吴颖猛, 叶红雨, 等. 食管癌术后消化道瘘的个体化治疗. 中国胸心血管外科临床杂志, 2011, 18(5): 469-471.
16. 刘金钢, 孙威. 腹腔镜胃癌根治术后吻合口漏的诊断与治疗. 中华普外科手术学杂志(电子版), 2015, 9(2): 86-89.
17. 胡祥, 张驰. 日本和韩国胃癌术后并发症诊断及风险评价. 中华胃肠外科杂志, 2017, 20(2): 129-134.
18. 刘文韬, 燕敏. 胃癌根治术后吻合口瘘原因及处理. 中国实用外科杂志, 2013, 33(4): 284-286.
19. 藏潞, 胡伟国, 郑民华. 腹腔镜胃癌根治术并发症及其预防. 中华胃肠外科杂志, 2013, 16(10): 940-943.
20. 祝子逸, 郦志军, 何正富, 等. 内镜引导下吻合口瘘冲洗治疗食管胃吻合口瘘合并瘘旁脓肿临床疗效观察. 浙江大学学报(医学版), 2017, 46(6): 637-642.
21. 李树海, 岳韦名, 李林, 等. 胸腹腔镜联合食管癌切除术后颈部残胃闭锁端瘘的诊治经验. 中华胸部外科电子杂志, 2016, 3(1): 56-58.
22. 金新天, 李志军, 殷波. 食管、贲门癌根治术后胸内吻合口瘘的治疗探讨. 四川医学, 2007, 28(3): 294-296.
23. Xu QY, Yin GW, Chen SX, et al. Fluoroscopically guided nose tube drainage of mediastinal abscesses in post-operative gastro-oesophageal anastomotic leakage. Br J Radiol, 2012, 85(1019): 1477-1481.
24. Segalin A, Bonavina L, Lazzerini M, et al. Endoscopic management of inveterate esophageal perforations and leaks. Surg Endosc, 1996, 10(9): 928-932.
25. Verstegen MHP, Bouwense SAW, van Workum F, et al. Management of intrathoracic and cervical anastomotic leakage after esophagectomy for esophageal cancer: a systematic review. World J Emerg Surg, 2019, 14: 17.
26. van Rossum PSN, Haverkamp L, Carvello M, et al. Management and outcome of cervical versus intrathoracic manifestation of cervical anastomotic leakage after transthoracic esophagectomy for cancer. Dis Esophagus, 2017, 30(1): 1-8.
27. Fumagalli U, Baiocchi GL, Celotti A, et al. Incidence and treatment of mediastinal leakage after esophagectomy: Insights from the multicenter study on mediastinal leaks. World J Gastroenterol, 2019, 25(3): 356-366.
28. Leers JM, Vivaldi C, Schäfer H, et al. Endoscopic therapy for esophageal perforation or anastomotic leak with a self-expandable metallic stent. Surg Endosc, 2009, 23(10): 2258-2262.
29. 陈华栋, 黄益, 邱永, 等. 国产自膨式带膜支架治疗食管-胃吻合口瘘的疗效. 实用医学影像杂志, 2007, 8(2): 115-118.

CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Individualized treatment of anastomotic leakage after laparoscopic D2 radical gastrectomy

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