Abstract: Objective:To explore the impact factors and effect of longer operation time of laparoscopic spleenpreserving splenic hilar lymph node dissection (SHLND).
Methods:The method of retrospective casecontrol study was adopted. The clinicopathological data of the 317 patients with upper or middlethird gastric cancer who underwent laparoscopic spleenpreserving SHLND at the Fujian Medical University Union Hospital between January 2011 and December 2013 were collected. Median operation time was served as a cutoff point, 148 patients with operation time≥24 minutes and 169 patients with operation time<24 minutes were allocated into the long time group and short time group, respectively. Impact factors affecting the operation time of laparoscopic spleenpreserving SHLND were analyzed firstly, and then operation time affecting clinical effect of patients was explored. Measurement data with normal distribution were presented as ±s and analyzed using an independent sample t test. Count data and univariate analysis were done using the chisquare test. Multivariate analysis was done using the Logistic regression model.
Results:The gender, body mass index (BMI), number of splenic lobar arteries, type of splenic lobar arteries, number of short gastric arteries and experiences of surgeons were factors affecting longer operation time of SHLND in the univariate analysis (χ²=7.268, 21.551, 14.960, 23.791, 6.987, 26.995, P<0.05). The male, BMI≥25 kg/m2, splenic lobar arteries≥3, dispersiontype of splenic lobar arteries and experiences of surgeons≤40 cases were independent risk factors affecting longer operation time of laparoscopic spleenpreserving SHLND in the multivariate analysis (OR=2.935, 8.539, 2.775, 2.084, 8.555; 95% confidence interval: 1.485-5.802, 2.979-24.476, 1.279-6.021, 1.217-3.569, 3.239-22.592, P< 0.05). The volume of blood loss in the splenic hilar area, time for postoperative semifluid diet intake and duration of postoperative hospital stay were (19±11)mL, (9.0±5.7)days and (13±9)days in the long time group and (13±10)mL, (7.8±2.4)days and (12±5)days in the short time group，respectively, with significant differences between the 2 groups (t=5.274, 2.501, 2.147, P<0.05). Of 317 patients, 23 patients had postoperative complications, with the incidence of complications was 5.41% (8/148) in the long time group and 8.88%(15/169) in the short time group, with no significant difference between the 2 groups (χ²=1.223, P>0.05). The mortalities were 0.68%(1/148)in the long time group and 0.59%(1/169)in the short time group, with no significant difference between the 2 groups (χ²=0.009, P>0.05).
Conclusion:Longer operation time of laparoscopic spleenpreserving SHLND is closely associated with gender, BMI, number of splenic lobar arteries, type of splenic lobar arteries and experiences of surgeons, and it should be performed selectively for inexperienced surgeons in order to reduce operation time and enhance postoperative recovery of patients.