Major perioperative complications in laparoscopic spleen-preserving total gastrectomy for gastric cancer: perspectives from a high-volume center

作者：Lu, Jun; Huang, Chang-ming^*; Zheng, Chao-hui; Li, Ping; Xie, Jian-wei; Wang, Jia-bin; Lin, Jian-xian; Chen, Qi-yue; cao, Long-long; Lin, Mi

来源：Surgical Endoscopy and Other Interventional Techniques, 2016, 30(3): 1034-1042.

DOI：10.1007/s00464-015-4291-x

• Major complications
• Laparoscopic spleen-preserving total gastrectomy
• Scoring system
• Gastric cancer

Background Laparoscopic spleen-preserving total gastrectomy (LSPTG) for gastric cancer is only performed at a few specialized institutions and carries the risk of major perioperative complications (MPCs) that may require reoperation and impair recovery. However, the predictors of such events remain largely unknown. @@@ Methods Prospectively collected data from 325 consecutive patients undergoing LSPTG at a single institution from June 2011 to February 2014 were analyzed to determine the preoperative factors that correlated with MPCs. The rates of MPCs were assessed, and a score model was developed to identify preoperative variables associated with MPC. @@@ Results Of the 325 LSPTG cases, the following types of MPCs were observed in 15 (4.6 %) patients: intraoperative splenic hilar vascular injury (n = 1); intraoperative splenic parenchymal injury (n = 5); intraoperative splenic infarction (n = 1); intraabdominal abscess that required radiological intervention [not under general anesthesia (n = 2)]; intra-abdominal bleeding that required reoperation under general anesthesia (n = 2); anastomotic hemorrhage that required reoperation under general anesthesia (n = 2); and death (n = 2). Three independent variables were correlated with MPCs in the multivariate analysis: body mass index (BMI) >= 25 kg/m(2) (odds ratio [OR] 3.992, 95 % confidence interval [CI] 1.210-13.175), tumor located at the greater curvature (OR 3.922, 95 % CI 1.194-12.880), and No. 10 LN metastases (OR 4.418, 95 % CI 1.250-13.770). A risk score consisting of one point for each preoperative risk factor (BMI >= 25 kg/m(2) or tumor location in the greater curvature), resulting in an overall score of 0-2 points for each patient, predicted an increased risk of MPCs. @@@ Conclusions BMI, tumor location, and No. 10 LN metastases were significantly associated with increased rates of MPCs. A simple, clinically relevant scoring system based on two preoperative variables was clinically useful in predicting MPC risk in patients undergoing LSPTG.

• 出版日期2016-3
• 单位福建医科大学