Complications with laparoscopically assisted gastrectomy: multivariate analysis of 300 consecutive cases

Abstract

Background Complications associated with laparoscopically assisted gastrectomy (LAG) are not significantly different from those associated with open gastrectomy. However, additional risks related to abdominal access, pneumoperitoneum, and special electrosurgical instruments result in an increased incidence of complications with LAG. This study analyzed the causes and risk factors linked to postoperative morbidity. Methods A retrospective review analyzed the data of 300 patients who underwent consecutive LAG for gastric cancer in our department from May 2003 to October 2006. Among the 300 patients, total gastrectomy was performed for 42 patients, distal gastrectomy for 258 patients, and proximal gastrectomy for 3 patients. The clinical and operative data obtained included body mass index, medical comorbidities, history of previous abdominal surgery, operative time, type of surgery, extent of lymph node dissection according to the Japanese Guideline, number of retrieved lymph nodes and lymph node metastases, additional operative procedure, depth of tumor invasion, and disease stage. The outcome data consisted of mortality, major morbidities, and postoperative hospital stay. The 300 cases were divided into two periods: 50 cases in the first period and 250 cases in the second period. Results Postoperative complications developed in 61 cases (20.3%), wound infection in 21 cases (7%), intraabdominal abscess in 3 cases (1%), bleeding in 12 cases (4%), stenosis in 13 cases (4.3%), leakage in 3 cases (1%), acute pancreatitis in 2 cases (0.7%), pulmonary complication in 4 cases (1.3%), renal complication in 4 cases (1.3%), and cardiac complication in 2 cases (0.7%). The 30-day mortality rate was 0.7% (n = 2). Univariate analysis proved that gender, operative period, comorbidity, and operative times were important risk factors. Multivariate analysis proved that cormobidity and operative period were important risk factors. Conclusion The data suggest that LAG can be performed with acceptable perioperative complication rates. The surgeon's experience and careful patient selection determined optimal patient outcomes.

Hospital Volume and Quality of Laparoscopic Gastrectomy in Japan

“…Adjusted OR time for LTG was approximately 60 min longer, which seemed to partially correspond with other combined studies that reported LTG being 20–60 min longer than LPG [18,19,20]. These studies evaluated data from a single high-volume center, while the findings of our study were from community-based centers and the variation of OR time between LPG and LTG was reasonable.…”

“…However, complications were restricted to surgical or procedure-related, but not medical, complications [18,19]. Hospital teaching status explained the variation of complications, while hospital volume was not associated with complications.…”

β-Shaped intracorporeal Roux-en-Y reconstruction after totally laparoscopic distal gastrectomy

“…However, we noted that it is very difficult to perform a gastrojejunostomy via a minilaparotomy in severely obese patients with a thick abdominal wall, even if the small incision is extended. Park et al [22] reported that 7 % (21/ 300) of patients experienced postoperative wound infection after LADG. In R-Y reconstruction after TLDG, the gastrojejunostomy is performed intracorporeally.…”

Effects of CO₂ Pneumoperitoneum on Peritoneal Macrophage Function and Peritoneal Metastasis in Mice with Gastric Cancer

“…Domestic and international multicenter, prospective, randomized, controlled clinical trials of the application of laparoscopic surgery to early gastric cancer treatment have shown the short-term efficacy of laparoscopic gastrectomy to be better than that of conventional laparotomy, while the long-term efficacy is equivalent [10]. Laparoscopic D2 radical gastrectomy has been confirmed to be technically safe and feasible for the treatment of progressive gastric cancer, and this technique has achieved good short-term efficacy [11,12]. Application of laparoscopy in gastric cancer surgery has been gradually developed domestically and internationally.…”

“…Since the first report of laparoscopic radical gastrectomy by Kitano et al [1] from Japan in 1994, this technique has resulted in impressive treatment outcomes [2,3,4] due to its significant advantage of minimal invasion as opposed to the traditional radical gastrectomy. However, in cases of progressive gastric cancer, particularly those with serosal invasion, it remains unclear whether CO 2 pneumoperitoneum affects peritoneal metastasis of gastric cancer after surgery.…”