Exploring the boundaries of anastomotic leak: experience in a high-volume center
Abstract Background Gastric cancer remains a major global health challenge, ranking fourth in cancer-related deaths. Total gastrectomy with lymphadenectomy is the standard treatment, with advancements in surgery shifting towards minimally invasive techniques to reduce surgical trauma and metabolic r...
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| Format: | Article |
| Language: | English |
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BMC
2025-01-01
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| Series: | World Journal of Surgical Oncology |
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| Online Access: | https://doi.org/10.1186/s12957-024-03622-z |
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| author | Carolina Riscanevo Bobadilla Gloria Flórez Dussan Jorge Vargas Liliana Suarez German Jimenez Carlos Gonzalez Andrea Carolina Córdoba Wilmar Martín Diego Olivera Raúl Guevara |
| author_facet | Carolina Riscanevo Bobadilla Gloria Flórez Dussan Jorge Vargas Liliana Suarez German Jimenez Carlos Gonzalez Andrea Carolina Córdoba Wilmar Martín Diego Olivera Raúl Guevara |
| author_sort | Carolina Riscanevo Bobadilla |
| collection | DOAJ |
| description | Abstract Background Gastric cancer remains a major global health challenge, ranking fourth in cancer-related deaths. Total gastrectomy with lymphadenectomy is the standard treatment, with advancements in surgery shifting towards minimally invasive techniques to reduce surgical trauma and metabolic response. Esophagojejunal anastomotic leak is a frequent complication of gastrectomy, significantly increasing morbidity and mortality rates by up to 64%. Materials and methods A retrospective cohort study reviewed adults undergoing total gastrectomy for gastric cancer who developed esophagojejunal anastomotic leaks. The study described patient characteristics, diagnostic methods, and management at Clinica Universitaria Colombia from 2013 to 2023. Results Among 500 patients who had total gastrectomy, 54 developed esophagojejunal leaks. The cohort was 64.8% male, average age 55.2 years (± 14.87), and average BMI 24.5 kg/m². Notably, 18.5% smoked, 11.1% had lung disease, and 9.3% had heart disease or diabetes. Chest tomography was used in 60% of cases, followed by endoscopy in 35.2%. Endoscopic management with fully covered stents was the main strategy, used in 84% of cases. Average hospitalization was 18 days, with 33% needing intensive care, and overall hospital stay was 23.31 ± 16.33 days. Patients undergoing neoadjuvant and elective laparoscopic surgeries had a significant 30-day mortality risk. Conclusions Despite advances in surgical techniques and perioperative management, esophagojejunal anastomotic leaks continue to represent a serious complication, increasing morbidity and mortality. Therefore, early postoperative detection, based on the patient’s clinical signs that allow confirmatory studies to be performed, is crucial. This facilitates the implementation of timely treatments, whether conservative, through the use of endoscopic or percutaneous strategies, or surgical procedures. The next step for the scientific community will be to conduct studies with long-term follow-ups to ensure consistency of the high-quality results reported so far. |
| format | Article |
| id | doaj-art-8c13d042e910438f9697091762aa2cba |
| institution | Kabale University |
| issn | 1477-7819 |
| language | English |
| publishDate | 2025-01-01 |
| publisher | BMC |
| record_format | Article |
| series | World Journal of Surgical Oncology |
| spelling | doaj-art-8c13d042e910438f9697091762aa2cba2025-01-19T12:25:49ZengBMCWorld Journal of Surgical Oncology1477-78192025-01-0123111010.1186/s12957-024-03622-zExploring the boundaries of anastomotic leak: experience in a high-volume centerCarolina Riscanevo Bobadilla0Gloria Flórez Dussan1Jorge Vargas2Liliana Suarez3German Jimenez4Carlos Gonzalez5Andrea Carolina Córdoba6Wilmar Martín7Diego Olivera8Raúl Guevara9Department of General Surgery, Sanitas University Foundation, Clínica Universitaria ColombiaGeneral Surgeon, Department of General Surgery, Clínica Universitaria ColombiaGeneral Surgeon, Department of General Surgery, Clínica Universitaria ColombiaGeneral Surgeon, Department of General Surgery, Clínica Universitaria ColombiaGeneral Surgeon, Department of General Surgery, Clínica Universitaria ColombiaGastroenterologist, Clínica Universitaria ColombiaGastroenterology Fellow, Sanitas University FoundationGeneral Surgeon, Department of General Surgery, Clínica Universitaria ColombiaDepartment of General Surgery, Sanitas University Foundation, Clínica Universitaria ColombiaGeneral Surgeon, Department of General Surgery, Clínica Universitaria ColombiaAbstract Background Gastric cancer remains a major global health challenge, ranking fourth in cancer-related deaths. Total gastrectomy with lymphadenectomy is the standard treatment, with advancements in surgery shifting towards minimally invasive techniques to reduce surgical trauma and metabolic response. Esophagojejunal anastomotic leak is a frequent complication of gastrectomy, significantly increasing morbidity and mortality rates by up to 64%. Materials and methods A retrospective cohort study reviewed adults undergoing total gastrectomy for gastric cancer who developed esophagojejunal anastomotic leaks. The study described patient characteristics, diagnostic methods, and management at Clinica Universitaria Colombia from 2013 to 2023. Results Among 500 patients who had total gastrectomy, 54 developed esophagojejunal leaks. The cohort was 64.8% male, average age 55.2 years (± 14.87), and average BMI 24.5 kg/m². Notably, 18.5% smoked, 11.1% had lung disease, and 9.3% had heart disease or diabetes. Chest tomography was used in 60% of cases, followed by endoscopy in 35.2%. Endoscopic management with fully covered stents was the main strategy, used in 84% of cases. Average hospitalization was 18 days, with 33% needing intensive care, and overall hospital stay was 23.31 ± 16.33 days. Patients undergoing neoadjuvant and elective laparoscopic surgeries had a significant 30-day mortality risk. Conclusions Despite advances in surgical techniques and perioperative management, esophagojejunal anastomotic leaks continue to represent a serious complication, increasing morbidity and mortality. Therefore, early postoperative detection, based on the patient’s clinical signs that allow confirmatory studies to be performed, is crucial. This facilitates the implementation of timely treatments, whether conservative, through the use of endoscopic or percutaneous strategies, or surgical procedures. The next step for the scientific community will be to conduct studies with long-term follow-ups to ensure consistency of the high-quality results reported so far.https://doi.org/10.1186/s12957-024-03622-zAnastomotic leakGastric cancerEsophageal stentGastrectomyEndoscopy |
| spellingShingle | Carolina Riscanevo Bobadilla Gloria Flórez Dussan Jorge Vargas Liliana Suarez German Jimenez Carlos Gonzalez Andrea Carolina Córdoba Wilmar Martín Diego Olivera Raúl Guevara Exploring the boundaries of anastomotic leak: experience in a high-volume center World Journal of Surgical Oncology Anastomotic leak Gastric cancer Esophageal stent Gastrectomy Endoscopy |
| title | Exploring the boundaries of anastomotic leak: experience in a high-volume center |
| title_full | Exploring the boundaries of anastomotic leak: experience in a high-volume center |
| title_fullStr | Exploring the boundaries of anastomotic leak: experience in a high-volume center |
| title_full_unstemmed | Exploring the boundaries of anastomotic leak: experience in a high-volume center |
| title_short | Exploring the boundaries of anastomotic leak: experience in a high-volume center |
| title_sort | exploring the boundaries of anastomotic leak experience in a high volume center |
| topic | Anastomotic leak Gastric cancer Esophageal stent Gastrectomy Endoscopy |
| url | https://doi.org/10.1186/s12957-024-03622-z |
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