Impact of anastomotic leak on long‐term survival in patients undergoing gastrectomy for gastric cancer. Issue 12 (13th June 2020) - Kamarajah, S. K.
Abstract : Background: The impact of anastomotic leak (AL) on long‐term outcomes after gastrectomy for gastric adenocarcinoma is poorly understood. This study determined whether AL contributes to poor overall survival. Methods: Consecutive patients undergoing gastrectomy in a single high‐volume unit between 1997 and 2016 were evaluated. Clinicopathological characteristics, oncological and postoperative outcomes were stratified according to whether patients had no AL, non‐severe AL or severe AL. Severe AL was defined as anastomotic leakage associated with Clavien–Dindo Grade III–IV complications. Results: The study included 969 patients, of whom 58 (6·0 per cent) developed AL; 15 of the 58 patients developed severe leakage. Severe AL was associated with prolonged hospital stay (median 50, 30 and 13 days for patients with severe AL, non‐severe AL and no AL respectively; P < 0·001) and critical care stay (median 11, 0 and 0 days; P < 0·001). There were no significant differences between groups in number of lymph nodes harvested (median 29, 30 and 28; P = 0·528) and R1 resection rates (7, 5 and 6·5 per cent; P = 0·891). Cox multivariable regression analysis showed that severe AL was independently associated with overall survival (hazard ratio 3·96, 95 per cent c.i. 2·11 to 7·44; P < 0·001) but not recurrence‐free survival. In sensitivity analysis, the results for patients who had neoadjuvant therapy then gastrectomy were similar to those for the entire cohort. Conclusion: AL prolongs hospital stay and is associated with compromised long‐term overall survival. Abstract : This study demonstrates that anastomotic leakage leads to prolonged critical care and in‐hospital stay, and is associated with compromised long‐term overall survival. Future research should aim at developing mechanisms and interventions to reduce the risk of anastomotic leaks. Leaks impair outcomes Abstract : Antecedentes: El impacto de la fuga anastomótica ( anastomotic leak, AL) tras una gastrectomía por adenocarcinoma gástrico sobre los resultados a largo plazo es poco conocido. En este estudio se investigó si la AL contribuye a una peor supervivencia global ( overall survival, OS). Métodos: Se analizaron todos los pacientes consecutivos sometidos a una gastrectomía en un centro de alto volumen entre 1997 y 2016. Las características clinicopatológicas, los resultados postoperatorios y los resultados oncológicos se clasificaron en función de la AL: no AL versus NSL ( Non-Severe Leak, fuga no grave) versus AL grave ( severe AL, SAL). SAL se definió como fugas anastomóticas asociadas con complicaciones Clavien‐Dindo grado III / IV. Resultados: Se incluyeron 969 pacientes en el estudio, de los cuales el 6% (58/969) presentó una AL. De los que desarrollaron AL, el 26% desarrolló SAL (15/58). SAL se asoció con una estancia prolongada en el hospital (mediana: 50 versus 30 versus 13 días, P < 0, 001) y en cuidados intensivos (mediana: 11 versus 0 versus 0 días, P < 0, 001) en comparación con NSL o sin AL. No hubo diferencias significativas en los ganglios linfáticos identificados (mediana: 28 versus 30 versus 29 P = 0, 5) ni en las tasas de resección R1 (mediana: 7% versus 5% versus 7%, P = 0, 9) entre no AL, NSL y SAL, respectivamente. La regresión multivariable de Cox demostraba que SAL se asociaba independientemente con la OS (cociente de riesgos instantáneos, hazard ratio, HR 3, 96, i.c. del 95% 2, 11‐7, 44, P < 0, 001) pero no la RFS. El análisis de sensibilidad en pacientes que recibieron tratamiento neoadyuvante y posteriormente gastrectomía fue similar a los que se sometieron únicamente a gastrectomía. Conclusión: La AL prolonga la estancia hospitalaria y compromete la supervivencia global a largo plazo.