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STUDYING RISK FACTORS FOR ANASTOMOSIS LEAKAGE FOLLOWING TOTAL AND SUBTOTAL GASTRECTOMY FOR GASTRIC CANCER
Mahmoud Adnan Soliman*, Ali Alloush and Aktham Kanjarawi
Background: Despite the significant improvement in surgical techniques, anastomotic leakage(AL) remains one of the most consequences that associated with high rates of morbidity and mortality. Objective: The aim of this study is to evaluate risk factors for ALs following gastric surgery. Materials and Methods: A prospective comparative study was conducted for the period two years (2020 - 2022) at Tishreen University Hospital in Lattakia-Syria. The study included 95 patients who underwent gastrectomy for stomach cancer. Results: Males represented 56.84 % of the patients and females 43.16%, with mean age 60 years. Tumors were most commonly located in the lower part of stomach (48.42%) followed by middle (34.74%) and upper parts (16.84%). Tumors stage III constitutes up approximately two-third of patients. Sub-total gastrectomy was applied in 72 patients (75.8%) and total gastrectomy in 23 patients (24.2%), with combined resection of other organs in 7 cases (7.37%). The rate of ALs was 13.68%. Male gender (p: 0.02), location of tumor (p: 0.008), complete resection of tumor (p: 0.04), combined resection of other organs (p: 0.0005), duration of surgery longer than 4 hours(p:0.02), blood loss during surgery more than 200 ml(p:0.01), serum level of albumin lower than 3.5 mg/dL (p: 0.01), and advanced stage of tumor(p:0.02) were risk factors for ALs after gastric resection. ALs were managed either by conservative management (69.23%) or surgically (30.77%), and mortality rate was 23.08% among patients with ALs. Conclusion: Anastomotic leakage represents a considerable risk for patient who underwent digestive surgery, with presence of many risk factors for development AL, so that we emphasis the importance of early detection of risk factors and taking preventive measures to improve final outcome.[Full Text Article]