Prognostic analysis of patients with intra-abdominal infectious complications after laparoscopic-assisted and open radical gastrectomy for gastric cancer - A propensity score-matching analysis

Risk prediction model for surgical site infection in patients with gastrointestinal cancer: a systematic review and meta-analysis

BACKGROUND

Currently, various risk prediction models for surgical site infection (SSI) in patients with gastrointestinal tumors have been developed, but comprehensive comparisons regarding the model construction process, performance, and data sample bias are lacking. This study conducts a systematic review of relevant research to evaluate the risk bias and clinical applicability of these models.

MATERIALS AND METHODS

The Web of Science, PubMed, Cochrane Library, Embase, CINAHL, CBM, CNKI, Wanfang, and VIP databases were searched for studies related to SSI prediction models in gastrointestinal cancer patients published up to August 19, 2024. Two researchers independently screened the literature, extracted the data, and evaluated the quality. A meta-analysis was conducted on the common predictive factors included in the model, using odds ratio (OR) values and 95% confidence interval (CI) as effect statistics. The Q test and heterogeneity index I2 were used to assess heterogeneity. All the statistical analyses were performed via Stata 16.0 software. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) checklist was submitted as a supplement.

RESULTS

A total of 28 articles were included, and 39 models were constructed. The area under the receiver operating characteristic curve (AUC) for the models ranged from 0.660 to 0.950, indicating good predictive performance. Eight studies conducted internal validation, eight studies conducted external validation, and two studies used a combination of internal and external validation for model evaluation. The overall risk of bias in the literature was high, but the applicability was good. The results of the meta-analysis revealed that factors such as underlying diseases, surgical factors, demographic factors, and laboratory-related indicators are the main predictors of surgical site infections in patients with gastrointestinal tumors.

CONCLUSIONS

Currently, risk prediction models for surgical site infections in patients with gastrointestinal cancer remain in the developmental phase, and there is a high risk of bias in the areas of study subjects, outcomes, and analysis. Researchers need to enhance research methodologies, conduct large-scale prospective studies, and refer to the reporting standards of the bias risk assessment tool for predictive models to construct predictive models with low bias risk and high applicability.

The learning curve of laparoscopic splenectomy and esophagogastric devascularization for portal hypertension with 10-year follow-up

INTRODUCTION AND OBJECTIVES

Laparoscopic splenectomy and esophagogastric devascularization (LSED) are minimally invasive, effective, and safe in treating esophageal-fundic variceal bleeding with portal hypertension (PHT). The study aimed to assess the learning curve of LSED by cumulative summation (CUSUM) analysis. The 10-year follow-up data for LSED and open surgery were also examined.

PATIENTS AND METHODS

Five hundred and ninety-four patients were retrospectively analyzed. Operation time, intraoperative blood loss, open operation conversion, and postoperative complications were selected as the evaluation indicators of surgical ability. The learning curve of LESD was assessed by the CUSUM approach. Patient features, perioperative indices, and 10-year follow-up data were examined.

RESULTS

Totally 236 patients underwent open surgery, and 358 underwent LSED. Patient characteristics were similar between groups. The LSED patients experienced less intraoperative blood loss, fewer complications, and faster recovery compared to the open surgery cohort. The learning curve of LESD was maximal for a case number of 50. Preoperative general characteristics were comparable for both stages. But the skilled stage had decreased operation time, reduced blood loss, less postoperative complications, and better recovery compared to the learning stage. The LSED group had higher recurrent hemorrhage-free survival rate and increased overall survival in comparison with cases administered open surgery in the 10-year follow-up. Free-liver cancer rates were similar between two groups.

CONCLUSIONS

About 50 cases are needed to master the LSED procedure. Compared to open surgery, LSED is a safer, feasible, and safe procedure for PHT patients, correlating with decreased rebleeding rate and better overall survival.

Risk factors of postoperative complications and their effect on survival after laparoscopic gastrectomy for gastric cancer

Background

The association between postoperative complications and long-term survival after laparoscopic gastrectomy (LG) for gastric cancer (GC) remains uncertain. This study aimed to determine the incidence and risk factors of postoperative complications and evaluate their impact on survival outcomes in patients undergoing LG.

Methods

A retrospective study was conducted on 621 patients who underwent LG for gastric adenocarcinoma between March 2015 and December 2021. Postoperative complications were classified according to the Clavien-Dindo classification, with major complications defined as Grade III or higher. Logistic regression models with stepwise backward procedure were used to identify risk factors for complications. To assess the impact of postoperative complications on survival, uni- and multi-variable Cox proportional hazard models were used for overall survival (OS) and disease-free survival (DFS).

Results

Overall rate of postoperative complications was 17.6% (109 patients); 33 patients (5.3%) had major complications. Independent risk factors for major complications were Charlson comorbidities index (OR [95% CI], 1.87 [1.09-3.12], p-value = 0.018 for each one score increase), and type of anastomosis (OR [95% CI], 0.28 [0.09-0.91], p-value = 0.029 when comparing Billroth II with Billroth I). Multivariable analysis identified major complications as an independent prognostic factor to reduce OS (HR [95% CI], 2.32 [1.02-5.30], p-value = 0.045) and DFS (HR [95% CI], 2.63 [1.37-5.06], p-value = 0.004). Other prognostic factors for decreased survival outcomes were tumor size, presence of invasive lymph nodes, and T4a stage.

Conclusions

Major complications rate of LG for GC was approximately 5.3%. Charlson comorbidities index and type of anastomosis were identified as risk factors for major postoperative complications. Major complications were demonstrated to pose adverse impact on survival outcomes.

Predictors for different types of surgical site infection in patients with gastric cancer: A systematic review and meta-analysis

Various factors contribute to different types of surgical site infections (SSI) in gastric cancer patients undergoing surgery, and the risk factors remain uncertain. This meta-analysis aims to clarify the relationship between various factors and SSI, resolving existing controversies. Thirty-four eligible articles with 66 066 patients were included in the meta-analysis. Significant risk factors for SSI included age ≥65 years, male gender, BMI ≥25 kg/m2, diabetes, hypertension, advanced TNM stage ≥III, pathologic T stage ≥T3, pathologic N stage ≥N1, ASA ≥3, open surgery, blood transfusion, extensive resection, combined resection, splenectomy, D2 or more lymph node dissection, and operative time ≥240 min. Operative time showed a nonlinear relationship with SSI risk. Subgroup analysis revealed significant differences in the effects of risk factors among different infection types. These findings inform the development of targeted preventive measures to reduce SSI rates.

Relationship between laparoscopic total gastrectomy-associated postoperative complications and gastric cancer prognosis

This study aimed to investigate the incidence and prognosis of postoperative complications after laparoscopic total gastrectomy (LTG) for gastric cancer (GC). We retrospectively enrolled 411 patients who underwent curative LTG for GC at seven institutions between January 2004 and December 2018. The patients were divided into two groups, complication group (CG) and non-complication group (non-CG), depending on the presence of serious postoperative complications (Clavien-Dindo grade III [≥ CD IIIa] or higher complications). Short-term outcomes and prognoses were compared between two groups. Serious postoperative complications occurred in 65 (15.8%) patients. No significant difference was observed between the two groups in the median operative time, intraoperative blood loss, number of lymph nodes harvested, or pathological stage; however, the 5-year overall survival (OS; CG 66.4% vs. non-CG 76.8%; p = 0.001), disease-specific survival (DSS; CG 70.1% vs. non-CG 76.2%; p = 0.011), and disease-free survival (CG 70.9% vs. non-CG 80.9%; p = 0.001) were significantly different. The Cox multivariate analysis identified the serious postoperative complications as independent risk factors for 5-year OS (HR 2.143, 95% CI 1.165-3.944, p = 0.014) and DSS (HR 2.467, 95% CI 1.223-4.975, p = 0.011). A significant difference was detected in the median days until postoperative recurrence (CG 223 days vs. non-CG 469 days; p = 0.017) between the two groups. Serious postoperative complications after LTG negatively affected the GC prognosis. Efforts to decrease incidences of serious complications should be made that may help in better prognosis in patients with GC after LTG.