Risk Factors And Prevention Of Anastomotic Leakage After Laparoscopic Total Gastrectomy

Objective:To explore the risk factors of postoperative esophagojejunal anastomotic leakage in patients with gastric cancer who underwent laparoscopic total gastrectomy,and to take feasible individual prevention and treatment measures to limit the occurrence and development of anastomotic leakage.Methods:A retrospective study was conducted to collect the clinical data of 266 patients with gastric cancer who underwent laparoscopic total gastrectomy in the Department of Gastrointestinal surgery of the second affiliated Hospital of Dalian Medical University from July 2014 to June 2019.According to the occurrence of esophagojejunal anastomotic leakage after operation,the patients were divided into two groups: anastomotic leakage group and non-anastomotic leakage group.Univariate analysis and Logistic regression were used to analyze the risk factors of anastomotic leakage after laparoscopic total gastrectomy.Results:Of the 266 patients,26 had esophagojejunal anastomotic leakage,with an incidence of 9.8%.Univariate analysis showed that there were significant differences in preoperative prealbumin,mode of operation,type of stapler,mode of digestive tract reconstruction,operation time and the number of lymph nodes d issected among the 6 groups(P<0.05):there were 17 cases of anastomotic leakage in patients with preoperative prealbumin level<240mg/L,with an incidence of 14.4%,which was higher than 6.1% in the group with prealbumin ?240mg/L be fore operation.Of the 96 patients undergoing totally laparoscopic surgery,16 had anastomotic leakage,with an incidence of 16.7%,which was significantly higher than 5.9% of patients undergoing Laparoscopic-assisted surgery(10/170).The incidence of anastomotic leakage in patients with linear stapler was 16.3%(15/92),with hand suture anastomosis was 16.7%(1/6),and that in circular stapler group was 6.0%(10/168).The incidence of anastomotic leakage in patients with Uncut Roux-en-Y anastomosis was 11.1%,and that in patients with ? anastomos is was 20.6%(7/34),and that in patients with Overlap anastomosis was 33.3%(2/6),and FEEA anastomosis group was 12.0%(3/25),and Roux-en-Y anastomosis group was 6.3%(11/174).In 66 patients with operation time<200min,anastomotic l eakage occurred in 12 cases(18.2%),which was higher than 7.0% in operation time?200min group 7.0%(14/200).In 124 cases with more than 30 lymph node dissection,anastomotic leakage occurred in 17 cases(13.7%),which was higher than 6.3% in lymph node dissection group<30(9/142).There was no significant difference in other 22 items(sex,age,BMI,hypertension,diabetes,coronary heart disease,preoperative hemoglobin,preoperative serum albumin,postoperative serum albumin and prealbumin,tumor markers,tumor location,anastomotic reinforcement,combined organ resection,indwelling gastric tube,number of drainage tubes,intraoperative blood loss,tumor histological grade,maximum tumor diameter,T,N and M stages)(P>0.05).Multivariate logistics analysis showed that total laparoscopic surgery and preoperative prealbumin<240mg/L were independent risk factors for esophagojejunal anastomotic leakage after laparoscopic total gastrectomy.Conclusion:Preoperative serum prealbumin level,total laparoscopic surgery,type of stapler,digestive tract reconstruction,intraoperative lymph node dissection and operation time were related to the incidence of anastomotic leakage after laparoscopic total gastrectomy.Preoperative serum prealbumin(<240mg/L)and the mode of operation(total laparoscopic surgery)were independent risk factors.Perioperative management should pay attention to improving the level of serum prealbumin,carefully select the mode of operation,instruments and digestive tract reconstruction,and avoid expanding the scope of lymph node dissection on the premise of radical operation.Early diagnosis and early treatment of anastomotic leakage.In order to reduce the occurrence of anastomotic leakage and mortality.