Top

World Journal of Surgery

Published in:

01-10-2012

Definition and Classification of Complications of Gastrectomy for Gastric Cancer Based on the Accordion Severity Grading System

Authors: Mi Ran Jung, Young Kyu Park, Jang Won Seon, Kwang Yong Kim, Oh Cheong, Seong Yeob Ryu

Published in: World Journal of Surgery | Issue 10/2012

Abstract

Background

Postoperative complications still comprise the marker used most frequently to assess the quality of gastrectomy. However, the definition and grading of morbidity is not standardized, hampering meaningful comparisons over time and among centers. This study proposes specific definitions and a reproducible classification of complications following gastrectomy using standardized grading tools.

Methods

We defined each complication based on the literature, and adopted the Accordion Severity Grading System to stratify morbidity. The classification was applied to 890 patients with gastric cancer seen between January 2010 and April 2011. The correlation between the complication grades and the length of hospital stay (LOS) was analyzed, and risk factors for complications were examined with special reference to severity grade.

Results

The overall morbidity rate was 18.1 %. Mild complications occurred in 31 patients (3.5 %), moderate in 77 patients (8.7 %), severe—invasive procedure/no general anesthesia (GA) in 27 patients (3.0 %), severe—invasive procedures/GA in 18 patients (2.0 %), and severe—organ failure in 3 patients (0.3 %). Five patients (0.6 %) died postoperatively. The grade of complications had a significant effect on the LOS (p < 0.001). Operating time and cardiovascular and pulmonary co-morbidities were independent risk factors for severe complications [odds ratio (OR) 1.001, p = 0.016; OR 2.226, p = 0.006; OR = 2.896, p = 0.003, respectively].

Conclusions

The complications after gastrectomy could be classified into different severity grades that had distinct clinical outcomes. The use of this classification provides more reliable, practical outcome data. Consequently, complications should be reported using a standardized classification tool such as the Accordion Severity Grading System, which requires consensus on the definition of specific complications.

Available only for authorised users

Low DE, Kuppusamy M, Hashimoto Y et al (2010) Comparing complications of esophagectomy and pancreaticoduodenectomy and potential impact on hospital systems utilizing the accordion severity grading system. J Gastrointest Surg 14:1646–1652PubMedCrossRef

Dindo D, Clavien PA (2008) What is a surgical complication? World J Surg 32:939–941. doi:10.1007/s00268-008-9584-y PubMedCrossRef

Martin RC 2nd, Brennan MF, Jaques DP (2002) Quality of complication reporting in the surgical literature. Ann Surg 235:803–813PubMedCrossRef

Clavien P, Sanabria J, Strasberg S (1992) Proposed classification of complication of surgery with examples of utility in cholecystectomy. Surgery 111:518–526PubMed

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 240:205–213PubMedCrossRef

Strasberg SM, Linehan DC, Hawkins WG (2009) The accordion severity grading system of surgical complications. Ann Surg 250:177–186PubMedCrossRef

Wu CW, Hsiung CA, Lo SS et al (2004) Randomized clinical trial of morbidity after D1 and D3 surgery for gastric cancer. Br J Surg 91:283–287PubMedCrossRef

Sasako M, Sano T, Yamamoto S et al (2008) D2 lymphadenectomy alone or with para-aortic nodal dissection for gastric cancer. N Engl J Med 359:453–462PubMedCrossRef

Degiuli M, Sasako M, Ponti A, Italian Gastric Cancer Study Group (2010) Morbidity and mortality in the Italian Gastric Cancer Study Group randomized clinical trial of D1 versus D2 resection for gastric cancer. Br J Surg 97:643–649PubMedCrossRef

10.

Kim HH, Hyung WJ, Cho GS et al (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 251:417–420PubMedCrossRef

11.

Lee JH, Park DJ, Kim HH et al (2011) Comparison of complications after laparoscopy-assisted distal gastrectomy and open distal gastrectomy for gastric cancer using the Clavien-Dindo classification. Surg Endosc 26:1287–1295PubMedCrossRef

12.

Jiang X, Hiki N, Nunobe S et al (2011) Postoperative outcomes and complications after laparoscopy-assisted pylorus-preserving gastrectomy for early gastric cancer. Ann Surg 253:928–933PubMedCrossRef

13.

Kumagai K, Hiki N, Nunobe S (2011) Different features of complications with Billroth I and Roux-en-Y reconstruction after laparoscopic-assisted distal gastrectomy. J Gastrointest Surg 15:2145–2152PubMedCrossRef

14.

Wente MN, Veit JA, Bassi C et al (2007) Postpancreatectomy hemorrhage (PPH): an International Study Group of Pancreatic Surgery (ISGPS) definition. Surgery 142:20–25PubMedCrossRef

15.

Bruce J, Krukowski ZH, Al-Khairy G et al (2001) Systematic review of the definition and measurement of anastomotic leak after gastrointestinal surgery. Br J Surg 88:1157–1168PubMedCrossRef

16.

Fukagawa T, Gotoda T, Oda I et al (2010) Stenosis of esophago-jejuno anastomosis after gastric surgery. World J Surg 34:1859–1863. doi:10.1007/s00268-010-0609-y PubMedCrossRef

17.

Frutos MD, Lujan J, Garcia A et al (2009) Gastrojejunal anastomotic stenosis in laparoscopic gastric bypass with a circular stapler (21 mm): incidence, treatment and long-term follow-up. Obes Surg 19:1631–1635PubMedCrossRef

18.

Park DJ, Lee HJ, Yang HK et al (2005) Predictors of operative morbidity and mortality in gastric cancer surgery. Br J Surg 92:1099–1102PubMedCrossRef

19.

Horan TC, Gaynes RP, Martone WJ et al (1992) CDC definitions of nosocomial surgical site infections, 1992: a modification of CDC definitions of surgical wound infections. Infect Control Hosp Epidemiol 13:606–608PubMedCrossRef

20.

Bassi C, Dervenis C, Butturini G et al (2005) Postoperative pancreatic fistula: an international study group (ISGPF) definition. Surgery 138:8–13PubMedCrossRef

21.

Sano T, Sasako M, Katai H et al (1997) Amylase concentration of drainage fluid after total gastrectomy. Br J Surg 84:1310–1312PubMedCrossRef

22.

Kiriyama S, Gabata T, Takada T et al (2010) New diagnostic criteria of acute pancreatitis. J Hepatobiliary Pancreat Sci 17:24–36PubMedCrossRef

23.

Dong K, Yu XJ, Li B et al (2006) Advances in mechanisms of postsurgical gastroparesis syndrome and its diagnosis and treatment. Chin J Dig Dis 7:76–82PubMedCrossRef

24.

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

25.

Asgeirsson T, El-Badawi KI, Mahmood A et al (2009) Postoperative ileus: it costs more than you expect. J Am Coll Surg 210:228–231PubMedCrossRef

26.

Kass R, Rustman LD, Zoetmulder FA (2001) Chylous ascites after oncological abdominal surgery: incidence and treatment. Eur J Surg Oncol 27:187–189CrossRef

27.

Assumpacao L, Cameron JL, Wolfgang CL et al (2008) Incidence and management of chyle leaks following pancreatic resection: a high volume single-center institutional experience. J Gastrointest Surg 12:1915–1923CrossRef

28.

Lin SZ, Hong-Fei T, Zhong-Lin N et al (2009) Treatment and prevention of lymphorrhea after radical gastrectomy of gastric cancer. J Cancer Res Clin Oncol 135:613–616CrossRef

29.

Jang HJ, Kim JH, Song HH et al (2008) Clinical outcomes of patients with liver cirrhosis who underwent curative surgery for gastric cancer: a retrospective multi-center study. Dig Dis Sci 53:399–404PubMedCrossRef

30.

Anonymous (1968) Nutritional anaemias: report of a WHO scientific group. World Health Organ Tech Rep Ser 405:5–37

31.

Clavien PA, Dindo D (2007) Surgeon’s intuition: is it enough to assess patient’s surgical risk? World J Surg 31:1909–1911. doi:10.1007/s00268-007-9145-9 PubMedCrossRef

32.

Heinrich S, Schafer M, Rousson V et al (2006) Evidence-based treatment of acute pancreatitis: a look at established paradigms. Ann Surg 243:154–168PubMedCrossRef

33.

Kim W, Song KY, Lee HJ et al (2008) The impact of comorbidity on surgical outcomes in laparoscopy-assisted distal gastrectomy: a retrospective analysis of multicenter results. Ann Surg 248(5):793–799PubMedCrossRef

34.

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

Title: Definition and Classification of Complications of Gastrectomy for Gastric Cancer Based on the Accordion Severity Grading System
Authors: Mi Ran Jung
Young Kyu Park
Jang Won Seon
Kwang Yong Kim
Oh Cheong
Seong Yeob Ryu
Publication date: 01-10-2012
Publisher: Springer-Verlag
Published in: World Journal of Surgery / Issue 10/2012
Print ISSN: 0364-2313
Electronic ISSN: 1432-2323
DOI: https://doi.org/10.1007/s00268-012-1693-y

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Definition and Classification of Complications of Gastrectomy for Gastric Cancer Based on the Accordion Severity Grading System

Abstract

Background

Methods

Results

Conclusions

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Background

Methods

Results

Conclusions

Please log in to get access to this content

Other articles of this Issue 10/2012

Value of Adrenal Venous Sampling for Lesion Localization in Primary Aldosteronism

Early Steroid Withdrawal Regimen Prevents New-Onset Diabetes Mellitus in Old-Age Recipients After Living Donor Liver Transplantation

Camel-Related Injuries: Prospective Study of 212 Patients

Key Performance Indicators in an Acute Surgical Unit: Have We Made an Impact?

Early Postoperative Vocal Function Evaluation After Thyroidectomy Using Thyroidectomy Related Voice Questionnaire

The Clinical Study of Precise Hemihepatectomy Guided by Middle Hepatic Vein