Our Summary

This research paper discusses a common complication after stomach cancer surgery known as anastomotic leakage (AL). This is when the area where the surgeon stitched the stomach back together leaks. This usually happens within a week or so after the operation. The chances of this happening are roughly 6% for traditional surgery and about 4% for keyhole surgery. Certain factors can increase the risk of this happening, such as a person’s general health and nutrition, although being overweight doesn’t seem to increase the risk. Surprisingly, having treatment before surgery seems to reduce the risk of AL.

There’s no difference in the risk of AL whether the surgery is done traditionally, by keyhole, or with a robot if only the lower part of the stomach is removed. However, if the whole stomach is removed, the risk of AL is higher. Measures to prevent AL, like draining fluids, don’t seem to work.

In terms of treatment for AL, it depends on how serious the leakage is. For mild cases, patients are put on a fast and given nutrition through a drip, antibiotics, and a small tube to drain the leakage. For small leaks, things like stents, vacuum therapy, clips, stitching devices, and injections can be used. In serious cases, where there is a large amount of leakage, or if the patient is very sick, or if other treatments haven’t worked, then another operation is needed.

FAQs

  1. What is the typical time frame for the manifestation of anastomotic leakage (AL) following gastrectomy?
  2. What are some of the risk factors for anastomotic leakage (AL) after gastrectomy?
  3. What are the treatment options for anastomotic leakage (AL) post-gastrectomy?

Doctor’s Tip

One helpful tip a doctor might tell a patient about gastrectomy is to closely follow postoperative care instructions, including proper wound care, medication management, and dietary guidelines to prevent complications such as anastomotic leakage. It is important to communicate any concerning symptoms or changes in condition to your healthcare provider promptly.

Suitable For

Patients who are typically recommended gastrectomy include those with gastric cancer, particularly those with advanced stages of the disease that cannot be effectively treated with other methods such as chemotherapy or radiation therapy. Other indications for gastrectomy may include peptic ulcers, gastrointestinal stromal tumors (GISTs), and severe gastroesophageal reflux disease (GERD) that does not respond to medication or lifestyle changes. Additionally, patients with a strong family history of gastric cancer or certain genetic syndromes that increase the risk of developing gastric cancer may also be recommended for prophylactic gastrectomy.

Timeline

Before gastrectomy:

  • Patient undergoes preoperative evaluations and tests to assess their overall health and suitability for surgery
  • Patient may receive neoadjuvant therapies such as chemotherapy or radiation to shrink the tumor before surgery
  • Patient may be placed on a special diet to optimize their nutritional status before surgery

After gastrectomy:

  • Patient typically stays in the hospital for a period of time to recover from the surgery
  • Patient may experience symptoms such as pain, nausea, and difficulty eating in the immediate postoperative period
  • Patient may receive enteral or parenteral nutrition support if they are unable to eat normally
  • Patient is monitored for signs of complications such as anastomotic leakage, which typically presents within 7 to 10 days post-surgery
  • Treatment for anastomotic leakage may involve conservative measures such as fasting, antibiotics, and drainage, as well as endoscopic or surgical interventions depending on the severity of the leakage.

What to Ask Your Doctor

  1. What is the overall risk of anastomotic leakage following gastrectomy for gastric cancer?
  2. What specific factors may increase my risk of developing anastomotic leakage?
  3. How does the type of gastrectomy (laparoscopic, robotic, open) affect the risk of anastomotic leakage?
  4. What are the recommended postoperative management strategies for preventing or treating anastomotic leakage?
  5. Are there any specific symptoms I should watch for that may indicate a potential anastomotic leakage?
  6. What are the potential complications associated with anastomotic leakage, and how are they typically managed?
  7. If anastomotic leakage does occur, what treatment options are available and which may be most appropriate for me?
  8. How will anastomotic leakage impact my recovery and long-term outcomes following gastrectomy?
  9. Are there any lifestyle or dietary changes I should consider to reduce my risk of anastomotic leakage or improve my overall surgical outcomes?
  10. How often will I need to follow up with my healthcare provider to monitor for potential complications related to anastomotic leakage?

Reference

Authors: Seicean RI, Puscasu D, Gheorghiu A, Pojoga C, Seicean A, Dindelegan G. Journal: J Gastrointestin Liver Dis. 2023 Dec 22;32(4):526-535. doi: 10.15403/jgld-5238. PMID: 38147605