Abstract: Objective:To analyze the ClavienDindo classification of complications after laparoscopyassisted gastrectomy (LAG) and investigate the relationship between risk factors and ClavienDindo classification of complications.
Methods:The retrospective casecontrol study was adopted. The clinical data of 578 〖HJ*3〗patients who underwent LAG at the Ruijin Hospital Affiliated to Shanghai Jiaotong University School of Medicine from January 2004 to December 2014 were collected. (1) The postoperative complications were observed and ClavienDindo classification was conducted. (2) There were the univariate and multivariate analyses in the basic conditions of patients, surgeryrelated and tumorrelated factors. (3) The relationship between risk factors and ClavienDindo classification of complications after LAG was analyzed. The followup of outpatient examination and telephone interview was performed to detect the survival of patients and tumor recurrence and metastases up to July 2015. Measurement data with normal distribution were presented as ±s. The univariate analysis and comparison of count data were done using the chisquare test, and multivariate analysis was done using the logistic regression model.
Results:Of 578 patients, 82 had postoperative complications, including 32 with anastomotic fistula, 10 with postoperative intestinal obstruction, 9 with intraperitoneal hemorrhage, 9 with intraperitoneal infection, 8 with anastomotic hemorrhage, 8 with delayed gastric emptying, 6 with anastomotic stenosis, 6 with duodenal stump fistula, 6 with lymphatic fistula, 2 with intestinal necrosis and 2 with incisional infection. A subset of patients had synchronous various complications. The ClavienDindo classification of complications: 2 patients were detected in stage Ⅰ, 60 in stage Ⅱ, 6 in stage Ⅲa, 12 in stage Ⅲb, 1 in stage Ⅳ and 1 in stage Ⅴ. The body mass index (BMI), anastomosis methods, volume of intraoperative blood loss, tumor diameter and N stage were related factors affecting complications after LAG in the univariate analysis (χ²=12.672, 15.608, 3.948, 3.989, 17.214, P<0.05). The BMI≥24 kg/m2 and BillrothⅡanastomosis were independent risk factors affecting complications after LAG in the multivariate analysis (RR=2.363, 3.581, 95% confidence interval: 1.421- 3.929, 1.680- 7.632, P<0.05). The numbers of patients in stage Ⅰ, Ⅱ, Ⅲa, Ⅲb, Ⅳ and Ⅴ of ClavienDindo classification were 1, 33, 6, 8, 1 and 0 with BMI<24 kg/m2, 1, 27, 0, 4, 0 and 1 with BMI≥24 kg/m2, 2, 24, 2, 5, 1 and 1 with Billroth I anastomosis, 0, 11, 0, 3, 0 and 0 with Billroth Ⅱanastomosis, 0, 25, 3, 4, 0 and 0 with RouxenY anastomosis, 0, 0, 1, 0, 0 and 0 with esophagogastrostomy, respectively. There were significant differences between different BMI or anastomosis methods and ClavienDindo classification of complications after LAG (χ²=20.237, 36.104, P<0.05). Of 578 patients, 1 was dead at postoperative month 1 and 534 were followed up for a median time of 44 months (range, 7-136 months). During followup, 49 patients (31 died of tumorrelated diseases and 18 died of nontumor diseases) were dead, 39 had tumors recurrence and metastases, and other patients had tumorfree survival.
Conclusions:Complications after LAG mainly include anastomosis fistula and stage Ⅱ of ClavienDindo classification. BMI≥24 kg/m2 and BillrothⅡanastomosis are independent risk factors affecting complications after LAG. BMI and anastomosis methods can affect the ClavienDindo classification of complications after LAG.