Risk Factors and Learning Curve Associated with Postoperative Morbidity of Laparoscopic Total Gastrectomy for Gastric Carcinoma

Jeong, Oh; Ryu, Sun-Youl; Choi, Won Yong; Piao, Zhengri; Park, Young Kyu

doi:10.1245/s10434-014-3666-x

Cited by 56 publications

(37 citation statements)

References 27 publications

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“…The present study found that postoperative morbidity significantly differed in the elderly, patients with more comorbidities, and those patients who underwent longer operation time. All of these factors had been reported in the previous studies, but the findings were not the same in those studies [27][28][29][30]. This difference may be due to the difference in the definitions of postoperative complications used, the different extents of lymphadenectomy, and the differences in surgeons' experience with the laparoscopic surgery.…”

Section: Discussionmentioning

confidence: 81%

“…In 2011, Lee et al [27] first used the Clavien-Dindo system to evaluate the postoperative complications in LDG and open distal gastrectomy. Recently, the incidences of morbidity rates for laparoscopic surgery vary from 11.0 to 25.3 % [27][28][29][30], and the complication rates for LTG are reported to be higher than those for LDG because of technical difficulties. However, in this study, the postoperative morbidity rate in LTG group was 15.1 % and the mortality rate was 0.4 %, which were slightly higher than that in the LDG group, but without statistically significant difference.…”

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

Evaluation of laparoscopic total gastrectomy for advanced gastric cancer: results of a comparison with laparoscopic distal gastrectomy

Huang

Zheng

et al. 2015

Surg Endosc

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Section: Discussionmentioning

confidence: 81%

Section: Discussionmentioning

confidence: 99%

Evaluation of laparoscopic total gastrectomy for advanced gastric cancer: results of a comparison with laparoscopic distal gastrectomy

Huang

Zheng

et al. 2015

Surg Endosc

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“…Indeed, our study identified a 30-day mortality rate of 5.2%. While some institutional studies have described zero percent mortality, database and multi-center collaborative studies consistently report significantly higher patient mortality (9, 11, 22–28). A recent multi-center study from the US Gastric Cancer Collaborative of 447 sub-total resections for gastric cancer between 2000 and 2012 reported a similar 4.9% mortality rate for all patients (29).…”

Section: Discussionmentioning

confidence: 99%

“…At present, gastric operations are largely resections for cancer or a part of high-volume bariatric subspecialty. Despite this perception, gastrectomy remains an important and morbid general surgery operation (7–11). A recent NSQIP study evaluating morbidity associated with gastrectomy for gastric cancer identified 5% post-operative mortality after total gastrectomy – higher than current mortality after major hepatectomy or pancreaticoduodenectomy (8, 12, 13).…”

Section: Introductionmentioning

confidence: 99%

Morbidity and Mortality After Gastrectomy: Identification of Modifiable Risk Factors

Martin

Das

Turrentine

et al. 2016

Journal of Gastrointestinal Surgery

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Background Morbidity after gastrectomy remains high. The potentially modifiable risk factors have not been well described. This study considers a series of potentially modifiable patient-specific and perioperative characteristics that could be considered to reduce morbidity and mortality after gastrectomy. Methods This retrospective cohort study includes adults in the ACS NSQIP PUF dataset who underwent gastrectomy between 2011 and 2013. Sequential multivariable models were used to estimate effects of clinical covariates on study outcomes including morbidity, mortality, readmission and reoperation. Results 3,678 patients underwent gastrectomy. A majority of patients had distal gastrectomy (N= 2,799, 76.1%) and had resection for malignancy (N= 2,316, 63.0%). 798 patients (21.7%) experienced a major complication. Reoperation was required in 290 patients (7.9%). 30-day mortality was 5.2%. Age (OR=1.01, 95% CI: 1.01–1.02, p=0.001), preoperative malnutrition (OR=1.65, 95% CI: 1.35–2.02, p<0.001), total gastrectomy (OR=1.63, 95% CI: 1.31–2.03, p<0.001), benign indication for resection (OR=1.60, 95% CI: 1.29–1.97, p<0.001), blood transfusion (OR=2.57, 95% CI: 2.10–3.13, p<0.001), and intraoperative placement of a feeding tubes (OR=1.28, 95% CI: 1.00–1.62, p=0.047) were independently associated with increased risk of morbidity. Association between tobacco use and morbidity was statistically marginal (OR=1.23, 95% CI: 0.99–1.53, p=0.064). All-cause postoperative morbidity had significant associations with reoperation, readmission, and mortality (all p<0.001). Conclusions Mitigation of perioperative risk factors including smoking and malnutrition as well as identified operative considerations may improve outcomes after gastrectomy. Postoperative morbidity has the strongest association with other measures of poor outcome: reoperation, readmission, and mortality.

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“…37 By contrast, Jung et al reported that the first generation of surgeons needed to conduct approximately 100 LTG cases to overcome the learning curve. 38 The first generation of surgeons who performed the technique did not have a standardized procedure or an established training system.…”

Section: Learning Curve Of Ltgmentioning

confidence: 99%

Laparoscopic Total Gastrectomy for Gastric Cancer

Jung

Kim

2015

J Minim Invasive Surg

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Laparoscopic total gastrectomy (LTG) has been more widely performed in the last decade because of improvements in the techniques and safety of laparoscopic distal gastrectomy. However, due to its technical difficulty, there are still concerns regarding the safety of LTG. Meta-analyses have shown that LTG is technically feasible, safe, and may offer advantages over open total gastrectomy for treatment of gastric cancer. Various methods of performing esophagojejunostomy have been developed in an effort to decrease the rate of anastomosis-related complications, and have ultimately improved the safety and acceptance of LTG. However, there is still a lack of level-one evidence in support of LTG. Conduct of large-scale, randomized clinical trials will be needed in order to verify the safety and efficacy of LTG. Therefore, we reviewed the current status and some of the controversies surrounding LTG.

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Risk Factors and Learning Curve Associated with Postoperative Morbidity of Laparoscopic Total Gastrectomy for Gastric Carcinoma

Abstract: LTG is a feasible technique with acceptable morbidity and mortality. However, substantial surgical experience is of most importance to reduce postoperative morbidity and mortality.

Cited by 56 publications

References 27 publications

Evaluation of laparoscopic total gastrectomy for advanced gastric cancer: results of a comparison with laparoscopic distal gastrectomy

Evaluation of laparoscopic total gastrectomy for advanced gastric cancer: results of a comparison with laparoscopic distal gastrectomy

Morbidity and Mortality After Gastrectomy: Identification of Modifiable Risk Factors

Laparoscopic Total Gastrectomy for Gastric Cancer

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