Total Gastrectomy for Gastric Malignancy: Trends Over 15 Years in Major Morbidity, Mortality, and Patient Selection From The National Surgical Quality Improvement Program.

IF 2 3区 医学 Q3 ONCOLOGY
Nicholas J Kelly, Neha Shafique, Gabriella N Tortorello, Gracia Vargas, John T Miura, Giorgos C Karakousis
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Abstract

Introduction: We examined trends in major morbidity and mortality following total gastrectomy for malignancy in a national cohort.

Methods: The National Surgical Quality Improvement Program was used to identify patients who underwent total gastrectomy for malignancy from 2007 to 2021. Joinpoint regression was used to determine annual percent changes (APCs) in thirty-day postoperative major morbidity, mortality, and length of stay (LOS). Major morbidity included deep and organ space surgical site infection, venous thromboembolism, cardiac event, pneumonia, acute renal failure, sepsis, and respiratory failure.

Results: Of 3515 patients, the median age was 65 years (IQR = 55-73), 59% were male, and 57.9% were White. Major morbidity was 23%, which did not change over time (APC = -1.4, 95% CI = -3.4 to 0.58), nor were there changes in individual morbidities with time. The most common morbidities were organ space surgical site infection (9.2%) and pneumonia (8.5%). Mortality rate in the study cohort was 2.7% and did not change (APC = -6.2, 95% CI = -13.0 to 1.1). LOS (median 9 days) also did not vary with time (APC = -2.3, 95% CI = -7.8 to 3.9). There was an increase in patients with diabetes (21.6% vs. 11.2%, p < 0.05), BMI ≥ 30 (31.1% vs. 18.2%, p < 0.05), and ASA IV-V status (11.6% vs. 3.5%, p < 0.05).

Conclusion: Morbidity and mortality following total gastrectomy for malignancy have not significantly changed over the last fifteen years. While this may in part be explained by increased patient comorbidity, efforts should be made to improve patient selection and mitigate postoperative complications to allow for timely adjuvant therapies.

胃恶性肿瘤全胃切除术:国家外科质量改进计划》15 年来的主要发病率、死亡率和患者选择趋势。
简介:我们研究了全国队列中恶性肿瘤全胃切除术后主要发病率和死亡率的趋势:我们研究了全国队列中恶性肿瘤全胃切除术后主要发病率和死亡率的趋势:方法:利用国家外科质量改进计划(National Surgical Quality Improvement Program)来识别 2007 年至 2021 年期间因恶性肿瘤接受全胃切除术的患者。采用连接点回归法确定术后三十天主要发病率、死亡率和住院时间(LOS)的年度百分比变化(APCs)。主要发病率包括深部和器官间隙手术部位感染、静脉血栓栓塞、心脏事件、肺炎、急性肾功能衰竭、败血症和呼吸衰竭:在3515名患者中,中位年龄为65岁(IQR=55-73),59%为男性,57.9%为白人。主要发病率为 23%,随着时间的推移没有变化(APC = -1.4, 95% CI = -3.4-0.58),单个发病率也没有变化。最常见的疾病是器官间隙手术部位感染(9.2%)和肺炎(8.5%)。研究队列中的死亡率为2.7%,没有变化(APC = -6.2,95% CI = -13.0至1.1)。住院时间(中位 9 天)也未随时间变化(APC = -2.3,95% CI = -7.8-3.9)。糖尿病患者有所增加(21.6% 对 11.2%,P 结论:全胃切除术后的发病率和死亡率并没有随着时间的推移而变化:过去十五年中,恶性肿瘤全胃切除术后的发病率和死亡率没有明显变化。虽然部分原因可能是患者合并症增加,但应努力改进患者选择,减少术后并发症,以便及时进行辅助治疗。
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来源期刊
CiteScore
4.70
自引率
4.00%
发文量
367
审稿时长
2 months
期刊介绍: The Journal of Surgical Oncology offers peer-reviewed, original papers in the field of surgical oncology and broadly related surgical sciences, including reports on experimental and laboratory studies. As an international journal, the editors encourage participation from leading surgeons around the world. The JSO is the representative journal for the World Federation of Surgical Oncology Societies. Publishing 16 issues in 2 volumes each year, the journal accepts Research Articles, in-depth Reviews of timely interest, Letters to the Editor, and invited Editorials. Guest Editors from the JSO Editorial Board oversee multiple special Seminars issues each year. These Seminars include multifaceted Reviews on a particular topic or current issue in surgical oncology, which are invited from experts in the field.
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