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01-05-2017

Complications and failure to rescue following laparoscopic or open gastrectomy for gastric cancer: a propensity-matched analysis

Authors: Ru-Hong Tu, Jian-Xian Lin, Chao-Hui Zheng, Ping Li, Jian-Wei Xie, Jia-Bin Wang, Jun Lu, Qi-Yue Chen, Long-Long Cao, Mi Lin, Chang-Ming Huang

Published in: Surgical Endoscopy | Issue 5/2017

Abstract

Background

To investigate the incidence of and factors associated with postoperative complications and failure to rescue following laparoscopic and open gastrectomy for gastric cancer.

Study design

We analyzed the records of 4124 patients who underwent a laparoscopic or open gastrectomy for gastric cancer. One-to-one propensity score matching was performed to compare the difference between the two groups.

Results

A total of 4124 patients were included in the study, 627 of whom (15.2 %) developed postoperative complications. Postoperative deaths occurred in 23 (0.6 %) patients with serious complications. In the propensity score matching analysis with 1361 pairs, no significant differences in the rates of overall complications (14.2 vs. 16.5 %, p = 0.093) were observed between laparoscopic and open gastrectomy group. In-hospital mortality decreased in patients who underwent laparoscopic gastrectomy compared to patients who underwent open gastrectomy (0.3 vs. 1.2 %, p = 0.004). Failure to rescue rates were lower in patients who underwent laparoscopic gastrectomy (2.1 vs. 7.6 %, p = 0.008). Multivariate analysis showed that older age, tumor location, TNM stage classification, extent of gastric resection, operative time and intra-operative blood loss were adverse risk factors for postoperative complications. Laparoscopic gastrectomy was found to be a protective factor for failure to rescue. Complications associated with failure to rescue included abdominal bleeding, anastomotic leakage and cardiac events. In-hospital mortality increased as the number of complications per patient increased.

Conclusions

Assuming equal competence with open and laparoscopic approaches of a surgeon, the proportion of patients with postoperative complications were similar among those who underwent laparoscopic gastrectomy compared to patients who underwent open gastrectomy. However, when complications occurred, patients with open gastrectomy were more likely to die.

Kitano S, Iso Y, Moriyama M, Sugimachi K (1994) Laparoscopy-assisted Billroth I gastrectomy. Surg Laparosc Endosc 4(2):146–148PubMed

Kitano S, Shiraishi N, Uyama I, Sugihara K, Tanigawa N, Japanese Laparoscopic Surgery Study Group (2007) A multicenter study on oncologic outcome of laparoscopic gastrectomy for early cancer in Japan. Ann Surg 245(1):68–72CrossRefPubMedPubMedCentral

Huscher CG, Mingoli A, Sgarzini G, Sansonetti A, Di Paola M, Recher A, Ponzano C (2005) Laparoscopic versus open subtotal gastrectomy for distal gastric cancer: five-year results of a randomized prospective trial. Ann Surg 241(2):232–237CrossRefPubMedPubMedCentral

Kim HH, Hyung WJ, Cho GS, Kim MC, Han SU, Kim W, Ryu SW, Lee HJ, Song KY (2010) Morbidity and mortality of laparoscopic gastrectomy versus open gastrectomy for gastric cancer: an interim report—a phase III multicenter, prospective, randomized Trial (KLASS Trial). Ann Surg 251:417–420CrossRefPubMed

Raval MV, Hamilton BH, Ko CY, Hall BL (2011) The importance of assessing both inpatient and outpatient surgical quality. Ann Surg 253:611–618CrossRefPubMed

Dimick JB, Staiger DO, Hall BL, Ko CY, Birkmeyer JD (2013) Composite measures for profiling hospitals on surgical morbidity. Ann Surg 257:67–72CrossRefPubMed

Birkmeyer JD, Dimick JB, Birkmeyer NJ (2004) Measuring the quality of surgical care: structure, process, or outcomes? J Am Coll Surg 198:626–632CrossRefPubMed

Silber JH, Rosenbaum PR, Schwartz JS, Ross RN, Williams SV (1995) Evaluation of the complication rate as a measure of quality of care in coronary artery bypass graft surgery. JAMA 274(4):317–323CrossRefPubMed

Silber JH, Rosenbaum PR, Williams SV, Ross RN, Schwartz JS (1997) The relationship between choice of outcome measure and hospital rank in general surgical procedures: implications for quality assessment. Int J Qual Health Care 9(3):193–200CrossRefPubMed

10.

Almoudaris AM, Burns EM, Bottle A, Aylin P, Darzi A, Vincent C, Faiz O (2013) Single measures of performance do not reflect overall institutional quality in colorectal cancer surgery. Gut 62(3):423–429CrossRefPubMed

11.

Wright JD, Ananth CV, Ojalvo L, Herzog TJ, Lewin SN, Lu YS, Neugut AI, Hershman DL (2013) Failure to rescue after major gynecologic surgery. Am J Obstet Gynecol 209(5):420.e421–420.e428CrossRef

12.

Ghaferi AA, Birkmeyer JD, Dimick JB (2009) Complications, failure to rescue, and mortality with major inpatient surgery in medicare patients. Ann Surg 250:1029–1034CrossRefPubMed

13.

Ghaferi AA, Birkmeyer JD, Dimick JB (2009) Variation in hospital mortality associated with inpatient surgery. N Engl J Med 361:1368–1375CrossRefPubMed

14.

Ghaferi AA, Birkmeyer JD, Dimick JB (2011) Hospital volume and failure to rescue with high-risk surgery. Med Care 49:1076–1081CrossRefPubMed

15.

Pasquali SK, He X, Jacobs JP, Jacobs ML, O’Brien SM, Gaynor JW (2012) Evaluation of failure to rescue as a quality metric in pediatric heart surgery: an analysis of the STS Congenital Heart Surgery Database. Ann Thorac Surg 94:573–580CrossRefPubMed

16.

Wright JD, Herzog TJ, Siddiq Z, Arend R, Neugut AI, Burke WM, Lewin SN, Ananth CV, Hershman DL (2012) Failure to rescue as a source of variation in hospital mortality for ovarian cancer. J Clin Oncol 30:3976–3982CrossRefPubMed

17.

Hu YF, Yu J, Zhang C, Wang YN, Cheng X, Huang F, Li GX (2010) Development and implementation of a clinical data mining system for gastric cancer surgery. Zhonghua Wei Chang Wai Ke Za Zhi 13(7):510–515PubMed

18.

Sobin LH, Gospodarowicz MK, Wittekind C (2010) International Union Against Cancer (UICC) TNM classification of malignant tumours, 7th edn. Wiley-Liss, New York

19.

Huang CM, Tu RH, Lin JX, Zheng CH, Li P, Xie JW, Wang JB, Lu J, Chen QY, Cao LL, Lin M (2015) A scoring system to predict the risk of postoperative complications after laparoscopic gastrectomy for gastric cancer based on a large-scale retrospective study. Medicine (Baltimore) 94(17):e812CrossRef

20.

Nakajima T (2002) Gastric cancer treatment guidelines in Japan. Gastric Cancer 5(1):1–5CrossRefPubMed

21.

Japanese Gastric Cancer Association (2011) Japanese gastric cancer treatment guidelines 2010 (ver. 3). Gastric Cancer 14:113–123CrossRef

22.

Wente MN, Veit JA, Bassi C, Dervenis C, Fingerhut A, Gouma DJ, Izbicki JR, Neoptolemos JP, Padbury RT, Sarr MG, Yeo CJ, Büchler MW (2007) Postpancreatectomy hemorrhage (PPH): an International Study Group of Pancreatic Surgery (ISGPS) definition. Surgery 142(1):20–25CrossRefPubMed

23.

Jung MR, Park YK, Seon JW, Kim KY, Cheong O, Ryu SY (2012) Definition and classification of complications of gastrectomy for gastric cancer based on the accordion severity grading system. World J Surg 36(10):2400–2411CrossRefPubMed

24.

Bruce J, Krukowski ZH, Al-Khairy G, Russell EM, Park KG (2001) Systematic review of the definition and measurement of anastomotic leak after gastrointestinal surgery. Br J Surg 88(9):1157–1168CrossRefPubMed

25.

Bassi C, Dervenis C, Butturini G, Fingerhut A, Yeo C, Izbicki J, Neoptolemos J, Sarr M, Traverso W, Buchler M, International Study Group on Pancreatic Fistula Definition (2005) Postoperative pancreatic fistula: an international study group (ISGPF) definition. Surgery 138(1):8–13CrossRefPubMed

26.

Orsenigo E, Bissolati M, Socci C, Chiari D, Muffatti F, Nifosi J, Staudacher C (2014) Duodenal stump fistula after gastric surgery for malignancies: a retrospective analysis of risk factors in a single centre experience. Gastric Cancer 17(4):733–744CrossRefPubMed

27.

Horan TC, Gaynes RP, Martone WJ, Jarvis WR, Emori TG (1992) CDC definitions of nosocomial surgical site infections, 1992: a modification of CDC definitions of surgical wound infections. Infect Control Hosp Epidemiol 13(10):606–608CrossRefPubMed

28.

Assumpcao L, Cameron JL, Wolfgang CL, Edil B, Choti MA, Herman JM, Geschwind JF, Hong K, Georgiades C, Schulick RD, Pawlik TM (2008) Incidence and management of chyle leaks following pancreatic resection: a high volume single-center institutional experience. J Gastrointest Surg 12(11):1915–1923CrossRefPubMed

29.

Holte K, Kehlet H (2000) Postoperative ileus: a preventable event. Br J Surg 87(11):1480–1493CrossRefPubMed

30.

Arozullah AM, Khuri SF, Henderson WG, Daley J, Participants in the National Veterans Affairs Surgical Quality Improvement Program (2001) Development and validation of a multifactorial risk index for predicting postoperative pneumonia after major noncardiac surgery. Ann Intern Med 135(10):847–857CrossRefPubMed

31.

Dindo D, Demartines N, Clavien PA (2004) Classification of surgical complications: a new proposal with evaluation in a cohort of 6336 patients and results of a survey. Ann Surg 240(2):205–213CrossRefPubMedPubMedCentral

32.

Tamirisa NP, Parmar AD, Vargas GM, Mehta HB, Kilbane EM, Hall BL, Pitt HA, Riall TS (2016) Relative contributions of complications and failure to rescue on mortality in older patients undergoing pancreatectomy. Ann Surg 263(2):385–391CrossRefPubMedPubMedCentral

33.

Yasunaga H, Horiguchi H, Kuwabara K, Matsuda S, Fushimi K, Hashimoto H, Ayanian JZ (2013) Outcomes after laparoscopic or open distal gastrectomy for early-stage gastric cancer: a propensity-matched analysis. Ann Surg 257(4):640–646CrossRefPubMed

34.

Lee JH, Han HS, Lee JH (2005) A prospective randomized study comparing open vs laparoscopy-assisted distal gastrectomy in early gastric cancer: early results. Surg Endosc 19:168–173CrossRefPubMed

35.

Guzman EA, Pigazzi A, Lee B, Soriano PA, Nelson RA, Benjamin Paz I, Trisal V, Kim J, Ellenhorn JD (2009) Totally laparoscopic gastric resection with extended lymphadenectomy for gastric adenocarcinoma. Ann Surg Oncol 16:2218–2223CrossRefPubMed

36.

Kim MC, Kim KH, Kim HH, Jung GJ (2005) Comparison of laparoscopy-assisted by conventional open distal gastrectomy and extraperigastric lymph node dissection in early gastric cancer. J Surg Oncol 91:90–94CrossRefPubMed

37.

Lee JH, Yom CK, Han HS (2009) Comparison of long-term outcomes of laparoscopy-assisted and open distal gastrectomy for early gastric cancer. Surg Endosc 23:1759–1763CrossRefPubMed

38.

Lee SI, Choi YS, Park DJ, Kim HH, Yang HK, Kim MC (2006) Comparative study of laparoscopy-assisted distal gastrectomy and open distal gastrectomy. J Am Coll Surg 202:874–880CrossRefPubMed

39.

Yamada H, Kojima K, Inokuchi M, Kawano T, Sugihara K (2008) Effect of obesity on technical feasibility and postoperative outcomes of laparoscopy-assisted distal gastrectomy—comparison with open distal gastrectomy. J Gastrointest Surg 12:997–1004CrossRefPubMed

40.

Vinuela EF, Gonen M, Brennan MF, Coit DG, Strong VE (2012) Laparoscopic versus open distal gastrectomy for gastric cancer: a meta-analysis of randomized controlled trials and high-quality nonrandomized studies. Ann Surg 255:446–456CrossRefPubMed

41.

Quan Y, Huang A, Ye M, Xu M, Zhuang B, Zhang P, Yu B, Min Z (2015) Comparison of laparoscopic versus open gastrectomy for advanced gastric cancer: an updated meta-analysis. Gastric Cancer. doi:10.1007/s10120-015-0516-x PubMed

42.

D’Agostino RB Jr (1998) Propensity score methods for bias reduction in the comparison of a treatment to a non-randomized control group. Stat Med 17(19):2265–2281CrossRefPubMed

43.

Kumagai K, Hiki N, Nunobe S, Jiang X, Kubota T, Aikou S, Tanimura S, Sano T, Yamaguchi T (2014) Potentially fatal complications for elderly patients after laparoscopy-assisted distal gastrectomy. Gastric Cancer 17(3):548–555CrossRefPubMed

44.

Hwang SH, Park DJ, Jee YS, Kim HH, Lee HJ, Yang HK, Lee KU (2009) Risk factors for operative complications in elderly patients during laparoscopy-assisted gastrectomy. J Am Coll Surg 208(2):186–192CrossRefPubMed

45.

Tu RH, Huang CM, Lin JX, Chen QY, Zheng CH, Li P, Xie JW, Wang JB, Lu J, Cao LL, Lin M (2015) A scoring system to predict the risk of organ/space surgical site infections after laparoscopic gastrectomy for gastric cancer based on a large-scale retrospective study. Surg Endosc. doi:10.1007/s00464-015-4594-y PubMedCentral

46.

Veenhof AA, Vlug MS, van der Pas MH, Sietses C, van der Peet DL, de Lange-de Klerk ES, Bonjer HJ, Bemelman WA, Cuesta MA (2012) Surgical stress response and postoperative immune function after laparoscopy or open surgery with fast track or standard perioperative care: a randomized trial. Ann Surg 255(2):216–221CrossRefPubMed

47.

Shibata J, Ishihara S, Tada N, Kawai K, Tsuno NH, Yamaguchi H, Sunami E, Kitayama J, Watanabe T (2015) Surgical stress response after colorectal resection: a comparison of robotic, laparoscopic, and open surgery. Tech Coloproctol 19(5):275–280CrossRefPubMed

48.

Ferraris VA, Bolanos M, Martin JT, Mahan A, Saha SP (2014) Identification of patients with postoperative complications who are at risk for failure to rescue. JAMA Surg 149(11):1103–1108CrossRefPubMed

49.

Sheetz KH, Krell RW, Englesbe MJ, Birkmeyer JD, Campbell DA Jr, Ghaferi AA (2014) The importance of the first complication: understanding failure to rescue after emergent surgery in the elderly. J Am Coll Surg 219(3):365–370CrossRefPubMedPubMedCentral

50.

Gonzalez AA, Dimick JB, Birkmeyer JD, Ghaferi AA (2014) Understanding the volume-outcome effect in cardiovascular surgery: the role of failure to rescue. JAMA Surg 149(2):119–123CrossRefPubMedPubMedCentral

Title: Complications and failure to rescue following laparoscopic or open gastrectomy for gastric cancer: a propensity-matched analysis
Authors: Ru-Hong Tu
Jian-Xian Lin
Chao-Hui Zheng
Ping Li
Jian-Wei Xie
Jia-Bin Wang
Jun Lu
Qi-Yue Chen
Long-Long Cao
Mi Lin
Chang-Ming Huang
Publication date: 01-05-2017
Publisher: Springer US
Published in: Surgical Endoscopy / Issue 5/2017
Print ISSN: 0930-2794
Electronic ISSN: 1432-2218
DOI: https://doi.org/10.1007/s00464-016-5235-9

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Complications and failure to rescue following laparoscopic or open gastrectomy for gastric cancer: a propensity-matched analysis

Abstract

Background

Study design

Results

Conclusions

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Background

Study design

Results

Conclusions

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