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.	孫益紅, 方勇. 胃癌根治術后吻合口相關并發癥的發生原因及防治要點. 中華胃腸外科雜志, 2017, 20(2): 144-147.
15.	黃偉釗, 吳穎猛, 葉紅雨, 等. 食管癌術后消化道瘺的個體化治療. 中國胸心血管外科臨床雜志, 2011, 18(5): 469-471.
16.	劉金鋼, 孫威. 腹腔鏡胃癌根治術后吻合口漏的診斷與治療. 中華普外科手術學雜志(電子版), 2015, 9(2): 86-89.
17.	胡祥, 張馳. 日本和韓國胃癌術后并發癥診斷及風險評價. 中華胃腸外科雜志, 2017, 20(2): 129-134.
18.	劉文韜, 燕敏. 胃癌根治術后吻合口瘺原因及處理. 中國實用外科雜志, 2013, 33(4): 284-286.
19.	藏潞, 胡偉國, 鄭民華. 腹腔鏡胃癌根治術并發癥及其預防. 中華胃腸外科雜志, 2013, 16(10): 940-943.
20.	祝子逸, 酈志軍, 何正富, 等. 內鏡引導下吻合口瘺沖洗治療食管胃吻合口瘺合并瘺旁膿腫臨床療效觀察. 浙江大學學報(醫學版), 2017, 46(6): 637-642.
21.	李樹海, 岳韋名, 李林, 等. 胸腹腔鏡聯合食管癌切除術后頸部殘胃閉鎖端瘺的診治經驗. 中華胸部外科電子雜志, 2016, 3(1): 56-58.
22.	金新天, 李志軍, 殷波. 食管、賁門癌根治術后胸內吻合口瘺的治療探討. 四川醫學, 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, Sch?fer 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.	陳華棟, 黃益, 邱永, 等. 國產自膨式帶膜支架治療食管-胃吻合口瘺的療效. 實用醫學影像雜志, 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. 孫益紅, 方勇. 胃癌根治術后吻合口相關并發癥的發生原因及防治要點. 中華胃腸外科雜志, 2017, 20(2): 144-147.
15. 黃偉釗, 吳穎猛, 葉紅雨, 等. 食管癌術后消化道瘺的個體化治療. 中國胸心血管外科臨床雜志, 2011, 18(5): 469-471.
16. 劉金鋼, 孫威. 腹腔鏡胃癌根治術后吻合口漏的診斷與治療. 中華普外科手術學雜志(電子版), 2015, 9(2): 86-89.
17. 胡祥, 張馳. 日本和韓國胃癌術后并發癥診斷及風險評價. 中華胃腸外科雜志, 2017, 20(2): 129-134.
18. 劉文韜, 燕敏. 胃癌根治術后吻合口瘺原因及處理. 中國實用外科雜志, 2013, 33(4): 284-286.
19. 藏潞, 胡偉國, 鄭民華. 腹腔鏡胃癌根治術并發癥及其預防. 中華胃腸外科雜志, 2013, 16(10): 940-943.
20. 祝子逸, 酈志軍, 何正富, 等. 內鏡引導下吻合口瘺沖洗治療食管胃吻合口瘺合并瘺旁膿腫臨床療效觀察. 浙江大學學報(醫學版), 2017, 46(6): 637-642.
21. 李樹海, 岳韋名, 李林, 等. 胸腹腔鏡聯合食管癌切除術后頸部殘胃閉鎖端瘺的診治經驗. 中華胸部外科電子雜志, 2016, 3(1): 56-58.
22. 金新天, 李志軍, 殷波. 食管、賁門癌根治術后胸內吻合口瘺的治療探討. 四川醫學, 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, Sch?fer 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. 陳華棟, 黃益, 邱永, 等. 國產自膨式帶膜支架治療食管-胃吻合口瘺的療效. 實用醫學影像雜志, 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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