How to identify early complications in patients undergoing distal gastrectomy?

Abstract

In this editorial we comment on the article by Zhang et al published in a recent issue of the World Journal of Gastrointestinal Surgery. Gastrectomy with appropriate lymph node dissection is still standard curative treatment in locally advanced gastric cancer. Several studies point out that gastric cancer surgery is a complex procedure that leads to a high risk of morbidity and mortality. Many factors can contribute to the onset of complications with consequent effects on prognosis and increased mortality. The complications can be divided in complications related to anastomosis, to motility and to surgical site infection. The study presented by Zhang B et al represent an interesting analysis on the possibility to prevent postoperative morbidity. The study was performed on 131 patients with distal gastric cancer who underwent gastrectomy with D2 lymph node dissection. Of these patients, 16% developed early postoperative complications. The univariate analysis showed that prealbumin level, hypertension, diabetes, history of abdominal surgery, R0 resection, and blood transfusion were factors influencing early postoperative complications after distal gastrectomy. Moreover, the inclusion of the above significant variables in the logistic regression analysis revealed that hypertension, diabetes, a history of abdominal surgery, and blood transfusion were independent predictors of postoperative complications. In conclusion, preoperative and intraoperative factors can be used to establish an early postoperative nomogram model. The results of the study presented by Zhang et al suggest that the prediction model can be used to guide the detection of postoperative complications and has clinical reference value.

Keywords: Gastric cancer; Gastrectomy; Lymph node dissection; Morbidity; Mortality; Surgical site infections

Core Tip: Surgical treatment is still the mainstay of curative gastric cancer treatment. The extent of lymphadenectomy is the only factor that can be influenced by the surgeon. Despite the therapeutic value of lymphadenectomy, mortality and complications are still high in gastric cancer surgery. The study presented by Zhang et al represent an interesting analysis on the possibility to prevent post-operative morbidity. The prediction model can be used to guide the detection of early postoperative complications.