TY - JOUR
T1 - Defining the Impact of Surgical Approach on Perioperative Outcomes for Patients with Gastric Cardia Malignancy
AU - Day, Ryan W.
AU - Badgwell, Brian D.
AU - Fournier, Keith F.
AU - Mansfield, Paul F.
AU - Aloia, Thomas A.
N1 - Publisher Copyright:
© 2015, The Society for Surgery of the Alimentary Tract.
PY - 2016/1/1
Y1 - 2016/1/1
N2 - Background: Gastric cardia cancer is currently treated with several operations. The purpose of the current study was to compare outcomes associated with three common operative approaches. Methods: The ACS-NSQIP Participant Use File was searched to identify all patients with gastric cardia malignancy who underwent total gastrectomy (TG), transhiatal esophagectomy (THE), or thoraco-abdominal esophagectomy (TAE) between 2005 and 2012. Demographic, perioperative risk factors, and outcomes were analyzed. Results: Overall, there were 982 patients identified in the database who met inclusion criteria. The median age was 65 years (range 20–88) and 807 (82.2 %) were male. The number of patients allocated to each approach was 204 TGs (20.8 %), 271 THE (27.6 %), and 507 TAE (51.6 %). All approaches had similar major morbidity, cardiopulmonary morbidity, and 30-day mortality, however, TAE was associated with the highest overall morbidity (TAE 49.9 % vs. TG 40.7 % and THE 43.5 %, p = 0.048). The independent risk factors predicting mortality were age greater than 65 years, history of myocardial infarction, and postoperative cardiopulmonary morbidity. Conclusions: For patients with proximal gastric cancer, the three most common operative approaches were associated with clinically-significant rates of overall and major morbidity. Approach-associated morbidity should be considered along with tumor location and extent when choosing a technique for resection of gastric cardia malignancy.
AB - Background: Gastric cardia cancer is currently treated with several operations. The purpose of the current study was to compare outcomes associated with three common operative approaches. Methods: The ACS-NSQIP Participant Use File was searched to identify all patients with gastric cardia malignancy who underwent total gastrectomy (TG), transhiatal esophagectomy (THE), or thoraco-abdominal esophagectomy (TAE) between 2005 and 2012. Demographic, perioperative risk factors, and outcomes were analyzed. Results: Overall, there were 982 patients identified in the database who met inclusion criteria. The median age was 65 years (range 20–88) and 807 (82.2 %) were male. The number of patients allocated to each approach was 204 TGs (20.8 %), 271 THE (27.6 %), and 507 TAE (51.6 %). All approaches had similar major morbidity, cardiopulmonary morbidity, and 30-day mortality, however, TAE was associated with the highest overall morbidity (TAE 49.9 % vs. TG 40.7 % and THE 43.5 %, p = 0.048). The independent risk factors predicting mortality were age greater than 65 years, history of myocardial infarction, and postoperative cardiopulmonary morbidity. Conclusions: For patients with proximal gastric cancer, the three most common operative approaches were associated with clinically-significant rates of overall and major morbidity. Approach-associated morbidity should be considered along with tumor location and extent when choosing a technique for resection of gastric cardia malignancy.
KW - GEJ
KW - Gastroesophageal junction
KW - NSQIP
KW - National Surgical Quality Improvement Program
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U2 - 10.1007/s11605-015-2949-2
DO - 10.1007/s11605-015-2949-2
M3 - Article
C2 - 26416411
AN - SCOPUS:84952979257
SN - 1091-255X
VL - 20
SP - 146
EP - 153
JO - Journal of Gastrointestinal Surgery
JF - Journal of Gastrointestinal Surgery
IS - 1
ER -