Postoperative Complications After Surgery for Gastric Cancer: Anastomotic Leakage



Fig. 16.1
Treatment algorithm





Five Key Points to Avoid Anastomotic Leakage






  • Optimize pre- and postoperative calorie intake.


  • Correct co-morbidities.


  • Make a tension-free anastomosis with vital tissue.


  • If the anastomosis is not perfect, redo.


  • Avoid postoperative NSAIDs.


Five Key Points to Diagnose and Manage Leakage






  • If signs of abdominal infection are seen postoperatively, start general treatment with antibiotics and hemodynamic support and order CT scan with the possibility to drain any leakage or abscess.


  • Percutaneous drainage is preferable if technically feasible.


  • Duodenal stump leakage requires surgical drainage, abdominal irrigation, and decompression of the duodenum.


  • Small anastomotic leaks can be managed with percutaneous drainage and nasoesophageal decompression.


  • Large anastomotic leaks may require endoscopic stent placement.


References



1.

Tokunaga M, Tanizawa Y, Bando E, Kawamura T, Terashima M. Poor survival rate in patients with postoperative intra-abdominal infectious complications following curative gastrectomy for gastric cancer. Ann Surg Oncol. 2013;20(5):1575–83.CrossRefPubMed


2.

de Steur WO, Henneman D, Allum WH, Dikken JL, van Sandick JW, Reynolds J, Mariette C, Jensen L, Johansson J, Kolodziejczyk P, Hardwick RH, van de Velde CJ; EURECCA Upper GI Group. Common data items in seven European oesophagogastric cancer surgery registries: towards a European upper GI cancer audit (EURECCA UpperGI). Eur J Surg Oncol. 2014;40(3):325–9. doi:10.1016/j.ejso.2013.11.021. Epub 2013 Dec 13.CrossRefPubMed


3.

Bonenkamp JJ, Hermans J, Sasako M, Welvaart K, Songun I, van de Velde CJH. Extended lymph node dissection for gastric cancer. N Engl J Med. 1999;340:908–14.CrossRefPubMed


4.

Cuschieri A, Favers P, Fielding J, Craven J, Bancewitcz J, Joypaul V, Cook P. Postoperative morbidity and mortality after D1 and D2 resections for gastric cancer: preliminary results of the MRC randomised controlled surgical trial. The Surgical Cooperative Group. Lancet. 1996;347:995–9.CrossRefPubMed
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Jun 28, 2016 | Posted by in GASTOINESTINAL SURGERY | Comments Off on Postoperative Complications After Surgery for Gastric Cancer: Anastomotic Leakage

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