The following factors were tested in the Cox proportional hazards model to determine their relationship to postoperative
hospital stay in 174 patients who underwent total
gastrectomy: age, sex, tumour stage, tumour free
resection margins,
anastomotic leakage, size of the EEA-stapler, preoperative
hospital stay, location of the anastomosis and additional resection. Only
anastomotic leakage and age independently affected postoperative
hospital stay. Leakage, confirmed radiologically, developed in 20 patients (11.5%) of whom four died postoperatively. Another six patients who did not develop leakage also died, giving a postoperative mortality of 5.7%. The median age of the patients was 68 years (range 30-87), and the median postoperative
hospital stay was 15 days (range 3-192). The operations were performed by 30 different surgeons of whom four performed more than ten, 9 performed 4-10 and 17 performed 1-3 total
gastrectomies. There was a significant difference in postoperative mortality- and
anastomotic leakage-rate between the surgeons who operated more than ten and less than four (p = 0.0122, p = 0.0453). However, when comparing the surgeons who operate more than 10 and 4-10 there was no difference in mortality or
anastomotic leakage (p = 0.3493, p = 0.8867). When comparing the surgeons who operated on 4-10 with less than 4 there was no difference in postoperative mortality, but the
anastomotic leakage rate was of borderline significance (p = 0.3916, p = 0.0582). Between the surgeons with the greatest experience there were significant differences as to leakage rate (p = 0.0003), time of operation (p < 0.001) but not in the number of thoracoabdominal incisions (p = 0.4939) or postoperative mortality (p = 0.8394). This study has shown conclusively that
anastomotic leakage is the most important factor for prediction of postoperative
hospital stay after total
gastrectomy.