Copyright
©The Author(s) 2019. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastroenterol. Jan 14, 2019; 25(2): 258-268
Published online Jan 14, 2019. doi: 10.3748/wjg.v25.i2.258
Novel abdominal negative pressure lavage-drainage system for anastomotic leakage after R0 resection for gastric cancer
Zhi-Fang Zheng, Jun Lu, Peng-Yang Zhang, Bin-Bin Xu, Chao-Hui Zheng, Ping Li, Jian-Wei Xie, Jia-Bin Wang, Jian-Xian Lin, Qi-Yue Chen, Chang-Ming Huang
Zhi-Fang Zheng, Jun Lu, Peng-Yang Zhang, Bin-Bin Xu, Chao-Hui Zheng, Ping Li, Jian-Wei Xie, Jia-Bin Wang, Jian-Xian Lin, Qi-Yue Chen, Chang-Ming Huang, Department of Gastric Surgery, Fujian Medical University Union Hospital, Fuzhou 350001, Fujian Province, China
Zhi-Fang Zheng, Jun Lu, Peng-Yang Zhang, Bin-Bin Xu, Chao-Hui Zheng, Ping Li, Jian-Wei Xie, Jia-Bin Wang, Jian-Xian Lin, Qi-Yue Chen, Chang-Ming Huang, Department of General Surgery, Fujian Medical University Union Hospital, Fuzhou 350001, Fujian Province, China
Jun Lu, Peng-Yang Zhang, Chao-Hui Zheng, Ping Li, Jian-Wei Xie, Jia-Bin Wang, Jian-Xian Lin, Qi-Yue Chen, Chang-Ming Huang, Key Laboratory of Ministry of Education of Gastrointestinal Cancer, Fujian Medical University, Fuzhou 350108, Fujian Province, China
Author contributions: Zheng ZF, Lu J, and Huang CM conceived of the study, analyzed the data, and drafted the manuscript; Zhang PY, Xu BB, Zheng CH, and Li P helped revise the manuscript critically for important intellectual content; Xie JW, Wang JB, Lin JX, and Chen QY helped collect the data and design the study. All authors read and approved the final manuscript.
Supported by Scientific and Technological Innovation Joint Capital Projects of Fujian Province, No. 2016Y9031; Construction Project of Fujian Province Minimally Invasive Medical Center, No. [2017]171; The Second Batch of Special Support Funds for Fujian Province Innovation and Entrepreneurship Talents, No. 2016B013; Youth Scientific Research Subject of Fujian Provincial Health and Family Planning Commission, No. 2015-1-37; and QIHANG Funds of Fujian Medical University, No. 2016QH025.
Institutional review board statement: This study was reviewed and approved by the Ethics Committee of the Fujian Medical University Union Hospital.
Informed consent statement: Patients were not required to give informed consent to the study because the analysis used anonymous clinical data that were obtained after each patient agreed to treatment by written consent.
Conflict-of-interest statement: To the best of our knowledge, no conflict of interest exists.
Data sharing statement: No additional data are available.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Corresponding author: Chang-Ming Huang, MD, Doctor, Professor, Department of Gastric Surgery, Fujian Medical University Union Hospital, No. 29, Xinquan Road, Fuzhou 350001, Fujian Province, China. hcmlr2002@163.com
Telephone: +86-591-83363366 Fax: +86-591-83363366
Received: October 31, 2018
Peer-review started: October 31, 2018
First decision: December 5, 2018
Revised: December 9, 2018
Accepted: December 19, 2018
Article in press: December 19, 2018
Published online: January 14, 2019
BACKGROUND
Anastomotic leakage (AL) is a severe complication associated with high morbidity and mortality after radical gastrectomy (RG) for gastric cancer (GC). We hypothesized that a novel abdominal negative pressure lavage-drainage system (ANPLDS) can effectively reduce the failure-to-rescue (FTR) and the risk of reoperation, and it is a feasible management for AL.
AIM
To report our institution’s experience with a novel ANPLDS for AL after RG for GC.
METHODS
The study enrolled 4173 patients who underwent R0 resection for GC at our institution between June 2009 and December 2016. ANPLDS was routinely used for patients with AL after January 2014. Characterization of patients who underwent R0 resection was compared between different study periods. AL rates and postoperative outcome among patients with AL were compared before and after the ANPLDS therapy. We used multivariate analyses to evaluate clinicopathological and perioperative factors for associations with AL and FTR after AL.
RESULTS
AL occurred in 83 (83/4173, 2%) patients, leading to 7 deaths. The mean time of occurrence of AL was 5.6 days. The AL rate was similar before (2009-2013, period 1) and after (2014-2016, period 2) the implementation of the ANPLDS therapy (1.7% vs 2.3%, P = 0.121). Age and malnourishment were independently associated with AL. The FTR rate and abdominal bleeding rate after AL occurred were respectively 8.4% and 9.6% for the entire period; however, compared with period 1, this significantly decreased during period 2 (16.2% vs 2.2%, P = 0.041; 18.9% vs 2.2%, P = 0.020, respectively). Moreover, the reoperation rate was also reduced in period 2, although this result was not statistically significant (13.5% vs 2.2%, P = 0.084). Additionally, only ANPLDS therapy was an independent protective factor for FTR after AL (P = 0.04).
CONCLUSION
Our experience demonstrates that ANPLDS is a feasible management for AL after RG for GC.
Core tip: A novel abdominal negative pressure lavage-drainage system (ANPLDS) can effectively reduce the failure-to-rescue and abdominal bleeding rate after anastomotic leakage (AL). Our experience demonstrates that ANPLDS is a feasible management for AL after radical gastrectomy for gastric cancer.
