@2024 Afarand., IRAN

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ISSN: 2252-0805    The Horizon of Medical Sciences 2015;20(4):203-207

Background
… [1-10] About 39% of the dead cases due to cancer in Iran are due to stomach cancer [11]. There is 18 to 60% survival in different countries [12]. … [13, 14] Even after the surgery, there is low (about 30%) 5-year survival [15], and most of the patients die due to metastasis [16]. … [17, 18]
Previous Studies
There are different studies about the differences between hand sutures and surgical staples methods. There are shorter length, less suture leak, less hospitalized length, and less death cases in sutures with surgical staples [2, 19-21].
Aim(s)
The aim of this study was to compare the complications and survival between hand suture and sutures with surgical staples in esophagojejunostomy following total gasterctomy.
Research type
This is a historical cohort study.
Research society, place and time
Patients with proximal cancer of the stomach and the mouth of the stomach, who needed total gasterctomy, referred to Baqiatallah Hospital (Tehran; Iran) from 2005 to 2011 were studied.
Sampling method and number
116 patients were selected, using census method
Used devices&materials
The hospitalized patients underwent surgery either through hand suture method (40 cases) or through sutures with surgical staples (76 cases with circular surgical stapler No. 25 and some cases with No. 28). There was no significant difference between two groups in age, gender, type of the tumor, and the disease stage. Short term effects including suture leak, suture removal, wound infection, and mortality after surgery during hospitalization up to discharge were recorded. Information was recorded in a researcher-made questionnaire. Content Validity method was used to determine the validity of the questionnaire. Test-retest method was used to investigate the reliability of the questionnaire. In the follow-up stage, which was at least one year after surgery, the available patients were called, and information of the dead persons was received from their closest family members. There was at least one year follow-up. Late complications, including anastomotic stenosis, hernia gap, and complementary therapies, and survival of the patients were followed up and recorded. Data was analyzed, using SPSS 20 software. Independent T test was used to compare demographic characteristics, tumor type and its location, information during surgery and after, and the related complications in the hospital between two groups. Kaplan-Meier and Cox Regression tests were used to investigate survival.
Findings by Text
87 patients (75%) were male. Mean age was 64.5±10.35years. There were hand sutures in 40 patients (34.5%) and sutures with surgical staples in 76 patients (65.5%). 70 patients (60.3%), 46 patients (39.7%), and 114 patients (98.3%) were with stomach proximal tumor, mouth of the stomach tumor, and adenocarcinoma, respectively. The frequency of other tumors was 2.5%. There was blood injection during surgery for 31 persons (26.7%), of whom 15 persons (37.5%) were from hand suture group and 16 persons (21.1%) were from surgical staples group, and there was a significant difference. Mean surgery lengths in hand suture group and surgical staples group were 273.9±50.7min and 252.3±65.8min, respectively. And there was no significant difference. There was suture leak in 6 cases with hand suture (15%) and 2 cases with surgical staples (2.6%), which showed a significant difference. There were 8 dead cases (20%) and 4 dead cases (5.3%) after surgery in hand suture and surgical staples methods, respectively. And this showed a significant difference. There was no significant difference between the hospitalized lengths in hand suture group (11.2±5.5 days) and surgical staples group (9.8±4.8 days). There was no significant difference between two methods in suture separation and infection in the surgery location. There was suture shortness in 9 patients (9.1%) of 99, containing 2 cases (5%) in hand suture group and 7 cases (9.2%) in surgical staples group. However, there was no significant difference. There was 31% one-year survival; and mean survival was 15.2±3.4 months. The closest relations were between age and disease stage and survival.
Main comparison to the similar studies
The patients mean age was 64.5±10.4 years. There are 67.4 years [22] and 58.5 years [19] patients’ mean ages, which are consistent with the present study. The frequency of stomach cancer in male persons was 75% that was 3 times of that of the female persons. There is 2 by 1 frequency ratio of male to female persons in the USA [1]. The frequency in Iran has been reported 3 by 1 [10]. The highest frequency was of adenocarcinoma cancer which was in 114 cases (98.3%). The most prevalent stomach malignant tumor is adenocarcinoma [1, 2], which is consistent with the present results. Mean surgery lengths in hand suture and surgical staples groups have been 260±75min and 250±68min, respectively. The result is consistent with the present results. Suture leak in hand suture group was 6.6%. There has been 4.54% suture leak, while there has been no suture leak in surgical staples group [10]. Suture leak is 3.27%, and there are 2.4% and 4.1% leak in hand suture and surgical staples groups, respectively [23]. There is 3.33% suture leak, and there are 3.3% and 4.5% leak in hand suture and surgical staples groups, respectively [20]. There is more suture leak in the present study than other studies. There are 1.6% and 1% patient death in hand suture and surgical staples groups, respectively [21]. In surgical staples method, 4.7% death has been reported due to the suture complications [2]. There are more deaths due to the complications in the present study than other studies. Mean hospitalized length was 10.3 days. Mean hospitalized length following total gasterctomy is 14 days [2]. Mean hospitalized lengths in hand suture and surgical staples groups are 9 and 6 days, respectively [19]. There was suture shortness in 9.1% of the cases. There is shortness of suture in 1.31% of the cases; and there is 1.6% suture shortness in hand suture group, while there is no suture shortness in surgical staples group [19]. There is 10% suture shortness in the surgical staples method [24]. In 4.63% of the cases, there are 1.5% and 4.9% suture shortness in hand suture and surgical staples groups, respectively [20]. There is shortness in 1.58% of the cases, and there are 0.5% and 3% suture shortness in hand suture and surgical staples groups, respectively [21]. There are more cases with suture shortness in the present study than other studies. There was one-year survival in 31% of the patients. There is one-year survival in 51.6% of the cases [17]. There are less survived cases in the present study than other studies. The closest relations were between age and disease stage and survival. The result is consistent with other studies [1, 22, 25].
Suggestions
Patient accurate follow-up planning, proper communication with the patients and their families (to enter into the treatment process), and observing the patients’ quality of life and their satisfaction should be included in the future studies.
Limitations
There was no possibility to control some factors such as comorbidities, nutritional status, history of chemo-radiotherapy, and the situation of the immune system.
Conclusions
Respecting lower leak and death after surgery, esophagojejunostomy with surgical staples is more efficient than hand suture method.
Acknowledgments
The university teachers of Surgery Department are appreciated.
Conflict of interest
Non-declared
Ethical Permissions
Non-declared
Funding Sources
The researcher paid all the costs.