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Morbidity and mortality after total gastrectomy for gastric malignancy using the American College of Surgeons National Surgical Quality Improvement Program database.
Bartlett, Edmund K; Roses, Robert E; Kelz, Rachel R; Drebin, Jeffrey A; Fraker, Douglas L; Karakousis, Giorgos C.
Afiliação
  • Bartlett EK; Department of Surgery, University of Pennsylvania, Philadelphia, PA.
  • Roses RE; Department of Surgery, University of Pennsylvania, Philadelphia, PA. Electronic address: Robert.Roses@uphs.upenn.edu.
  • Kelz RR; Department of Surgery, University of Pennsylvania, Philadelphia, PA.
  • Drebin JA; Department of Surgery, University of Pennsylvania, Philadelphia, PA.
  • Fraker DL; Department of Surgery, University of Pennsylvania, Philadelphia, PA.
  • Karakousis GC; Department of Surgery, University of Pennsylvania, Philadelphia, PA.
Surgery ; 156(2): 298-304, 2014 Aug.
Article em En | MEDLINE | ID: mdl-24947651
BACKGROUND: Frequent perioperative morbidity and mortality have been observed in randomized surgical studies for gastric cancer, but specific patient factors associated with morbidity and mortality after total gastrectomy have not been well characterized. METHODS: We queried the American College of Surgeons National Surgical Quality Improvement Program database (2005-2011) for all patients with a gastric neoplasm undergoing total gastrectomy. Univariate and multivariate logistic regression analyses were performed to identify factors associated with an increased risk of morbidity or mortality. RESULTS: In 1,165 patients undergoing total gastrectomy, 416 patients (36%) experienced a complication, and 55 died (4.7%) within 30 days of operation. In a reduced multivariate model, age >70 years, preoperative weight loss, splenectomy, and pancreatectomy were associated with morbidity, whereas age >70 years, weight loss, albumin <3 g/dL, and pancreatectomy were associated with mortality (P < .05 each). The number of present preoperative risk factors stratified morbidity from 26 to 46%, with an adjacent organ resection (splenectomy, pancreatectomy) associated with 56% morbidity. Similarly, mortality rates ranged from 0.4% in those without risk factors to 5 of 9 patients with all three preoperative factors present. Patients undergoing pancreatectomy had a 13% mortality rate. CONCLUSION: Total gastrectomy for malignancy is associated with substantial morbidity and mortality. Identification of high-risk factors may allow more rational patient selection or sequencing of therapy.
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Texto completo: 1 Coleções: 01-internacional Base de dados: MEDLINE Assunto principal: Neoplasias Gástricas / Gastrectomia Tipo de estudo: Clinical_trials / Etiology_studies / Prognostic_studies / Risk_factors_studies Aspecto: Implementation_research Limite: Aged / Female / Humans / Male / Middle aged País/Região como assunto: America do norte Idioma: En Revista: Surgery Ano de publicação: 2014 Tipo de documento: Article País de publicação: Estados Unidos
Texto completo
Adicionar na Minha BVS
Imprimir
XML
PubMed Links
Buscar no Google

Texto completo: 1 Coleções: 01-internacional Base de dados: MEDLINE Assunto principal: Neoplasias Gástricas / Gastrectomia Tipo de estudo: Clinical_trials / Etiology_studies / Prognostic_studies / Risk_factors_studies Aspecto: Implementation_research Limite: Aged / Female / Humans / Male / Middle aged País/Região como assunto: America do norte Idioma: En Revista: Surgery Ano de publicação: 2014 Tipo de documento: Article País de publicação: Estados Unidos