Prevention of Anastomotic Leakage after Total Gastrectomy with Perioperative Supplemental Oxygen Administration: A Prospective Randomized, Double-blind, Controlled, Single-center Trial
- 1k Downloads
The role of supplemental oxygen therapy in the healing of esophagojejunal anastomosis is still very much in an experimental stage. The aim of the present prospective, randomized study was to assess the effect of administration of perioperative supplemental oxygen therapy on esophagojejunal anastomosis, where the risk of leakage is high.
We enrolled 171 patients between January 2009 and April 2012 who underwent elective open esophagojejunal anastomosis for gastric cancer. Patients were assigned randomly to an oxygen/air mixture with a fraction of inspired oxygen (FiO2) of 30 % (n = 85) or 80 % (n = 86). Administration commenced after induction of anesthesia and was maintained for 6 h after surgery.
The overall anastomotic leak rate was 14.6 % (25 of 171): 17 patients (20 %) had an anastomotic dehiscence in the 30 % FiO2 group and 8 (9.3 %) in the 80 % FiO2 group (P < 0.05). The risk of anastomotic leak was 49 % lower in the 80 % FiO2 group (relative risk 0.61; 95 % confidence interval 0.40–0.95) versus 30 % FiO2.
Supplemental 80 % FiO2 provided during and for 6 h after major gastric cancer surgery to reduce postoperative anastomotic dehiscence should be considered part of ongoing quality improvement activities related to surgical care, with few risks to the patient and little associated cost.
KeywordsAnastomotic Leakage Supplemental Oxygen Anastomotic Dehiscence Ketorolac Tromethamine Esophagojejunal Anastomosis
- 9.Clarkson AN, Sutherland BA, Appleton I. The biology and pathology of hypoxia–ischemia: an update. Arch Immunol Ther Exp. 2005;53:213–25.Google Scholar
- 15.West JB. Respiratory physiology—the essentials. Bethesda, MD: Williams & Willkins; 1999.Google Scholar
- 19.American Society of Anesthesiologists. New classification of physiology status. Anesthesiologists. 1963;24:111.Google Scholar
- 22.Hermanek P, Sobin LH, eds. UICC TNM classification of malignant tumors. 4th ed. 2nd revised edition. Berlin: Springer; 1982.Google Scholar
- 33.Tornero-Campello G. Letter: Randomized clinical trial to evaluate the effects of perioperative supplemental oxygen administration on the colorectal anastomosis (Br J Surg. 2006;93:698–706). Br J Surg. 2006;93:1148.Google Scholar
- 34.García-Botello SA. Author's reply: Randomized clinical trial to evaluate the effects of perioperative supplemental oxygen administration on the colorectal anastomosis (Br J Surg. 2006;93:698–706). Br J Surg. 2006;93:1148–1149.Google Scholar
- 36.Sala C, García-Granero E, Martí R. Anastomotic pHi monitoring after colorectal surgery. Design and preliminary results. Br J Surg. 1994;81:35.Google Scholar