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Efficacy of endoscopic management for anastomotic leakage after gastrectomy in patients with gastric cancer

Kim, Young-Il and Lee, Jong Yeul and Khalayleh, Harbi and Kim, Chan Gyoo and Yoon, Hong Man and Kim, Soo Jin and Yang, Hannah and Ryu, Keun Won and Choi, Il Ju and Kim, Young-Woo (2022) Efficacy of endoscopic management for anastomotic leakage after gastrectomy in patients with gastric cancer. Surgical Endoscopy, 36 (5). pp. 2896-2905. ISSN 0930-2794. PMCID PMC9001531. doi:10.1007/s00464-021-08582-z.

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Background: Anastomotic leakage (AL) after gastrectomy in gastric cancer patients is associated with high mortality rates. Various endoscopic procedures are available to manage this postoperative complication. The aim of study was to evaluate the outcome of two endoscopic modalities, clippings and stents, for the treatment of AL. Patients and methods: There were 4916 gastric cancer patients who underwent gastrectomy between December 2007 and January 2016 at the National Cancer Center, Korea. A total of 115 patients (2.3%) developed AL. Of these, 85 patients (1.7%) received endoscopic therapy for AL and were included in this retrospective study. The endpoints were the complete leakage closure rates and risk factors associated with failure of endoscopic therapy. Results: Of the 85 patients, 62 received endoscopic clippings (with or without detachable snares), and 23 received a stent insertion. Overall, the complete leakage closure rate was 80%, and no significant difference was found between the clipping and stent groups (79.0% vs. 82.6%, respectively; P = 0.89). The complete leakage closure rate was significantly lower in the duodenal and jejunal stump sites (60%) than esophageal sites (86.1%) and gastric sites (94.1%; P = 0.026). The multivariate analysis showed that stump leakage sites (adjusted odds ratio [aOR], 4.51; P = 0.031) and the presence of intra-abdominal abscess (aOR, 4.92; P = -0.025) were associated with unsuccessful leakage closures. Conclusions: Endoscopic therapy using clippings or stents is an effective method for the postoperative management of AL in gastric cancer patients. This therapy can be considered a primary treatment option due to its demonstrated efficacy, safety, and minimally invasive nature.

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Kim, Young-Woo0000-0002-1559-9672
Additional Information:© The Author(s) 2021. This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit Received 02 February 2021; Accepted 02 June 2021; Published 12 July 2021. This work was supported by grants NCC-1410130, NCC-1710120, and NCC-2010090 from the National Cancer Center, Korea. Author Contributions: Study conceptions and design: YWK, JYL, acquisition of data: All authors, analysis and interpretation of data: YWK, YIK, JYL, drafting of the manuscript: YWK, YIK, JYL, KH and critical revision of the manuscript: all authors. Disclosure: Drs. Young-Il Kim, Jong Yeul Lee, Harbi Khalayleh, Chan Gyoo Kim, Hong Man Yoon, Soo Jin Kim, Hannah Yang, Keun Won Ryu, Il Ju Choi, Young-Woo Kim have no conflicts of interest or financial ties to disclose. Ethical approval: This study was approved by the Institutional Review Board of the National Cancer Center. Date of approval 28.09.2016. Informed consent: The IRB waived the need for informed consent for this retrospective study (IRB. No. NCC2016-0229).
Funding AgencyGrant Number
National Cancer Center (Korea)NCC-1410130
National Cancer Center (Korea)NCC-1710120
National Cancer Center (Korea)NCC-2010090
Subject Keywords:Anastomotic leakage; Endoscopic therapy; Gastrectomy
Issue or Number:5
PubMed Central ID:PMC9001531
Record Number:CaltechAUTHORS:20210722-151524737
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Official Citation:Kim, YI., Lee, J.Y., Khalayleh, H. et al. Efficacy of endoscopic management for anastomotic leakage after gastrectomy in patients with gastric cancer. Surg Endosc 36, 2896–2905 (2022).
Usage Policy:No commercial reproduction, distribution, display or performance rights in this work are provided.
ID Code:109976
Deposited By: Tony Diaz
Deposited On:26 Jul 2021 23:40
Last Modified:28 Apr 2022 16:30

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