Abstract: Objective:To investigate the impact of preoperative comorbidities on the abdominal complications after laparoscopeassisted total gastrectomy (LATG) for gastric cancer.
Methods:The retrospective casecontrol study was conducted. The clinical data of 1 657 gastric cancer patients who underwent LATG at the Fujian Medical University Union Hospital between January 2008 and December 2015 were collected. There were 175 patients with postoperative abdominal complications, including 78 without preoperative comorbidities and 97 with preoperative comorbidities (52 with 1 comorbidity, 30 with 2 comorbidities and 15 with more than 3 comorbidities). Analysis method and observation indicators: (1) risk factors analysis of abdominal complications after LATG; (2) risk assessment of abdominal complications after LATG: independent influencing factors of risk factors analysis were expressed as dependent variables, alignment diagram was built and then consistency index was calculated; (3) comparisons of abdominal complications among the patients with different kinds of comorbidities after LATG; (4) multivariate analysis of abdominal complications in patients with comorbidities after LATG; (5) followup situations. Followup using outpatient examination and telephone interview was performed to detect postoperative survival of patients up to May 2016. The univariate analysis and multivariate analysis were respectively done using the chisquare test and Logistic regression model. The survival rate was calculated by the KaplanMeier method.
Results:(1) Risk factors analysis of abdominal complications after LATG: results of univariate analysis showed that age, body mass index (BMI), number of preoperative comorbidities, operation time and estimated volume of intraoperative blood loss were related factors affecting abdominal complications of patients after LATG (x²=4.487, 16.602, 10.361, 4.567, 7.482, P<0.05). Results of multivariate analysis showed that BMI, number of preoperative comorbidities and estimated volume of intraoperative blood loss were independent factors affecting abdominal complications of patients after LATG ［OR=1.966, 1.204, 1.423, 95% confidence interval (CI): 1.355-2.851, 1.014-1.431, 1.013-1.999, P<0.05］. (2) Risk assessment of abdominal complications after LATG: BMI, number of preoperative comorbidities and estimated volume of intraoperative blood loss were expressed as dependent variables, and the alignment diagram on risk prediction of abdominal complications after LATG was built, with a consistency index of 0.703. (3) Comparisons of abdominal complications among the patients with different kinds of comorbidities after LATG: numbers of patients without comorbidity, with 1 comorbidity, 2 comorbidities and ≥3 comorbidities were detected in 21, 8, 13, 3 patients with intraabdominal infection and 13, 10, 9, 5 patients with anastomotic leakage and 6, 3, 6, 2 patients with intraabdominal bleeding, respectively, with statistically significant differences (x²=10.677, 10.436, 9.245, P<0.05). (4) Multivariate analysis of abdominal complications in patients with comorbidities after LATG: BMI≥ 25 kg/m2 and estimated volume of intraoperative blood loss >82 mL were independent risk factors affecting abdominal complications of patients with preoperative comorbidities after LATG (OR=2.104, 1.771 ,95%CI: 1.307-3.387, 1.146-2.738, P<0.05). (5) Followup situations: of 1 657 patients, 1 568 were followed up for 4-99 months, with a median time of 47 months. Ninetyseven patients with preoperative comorbidities undergoing LATG had postoperative abdominal complications and were followed up. During followup, 5year survival rate of patients was 58.1%, and 5year survival rate of 97 patients with preoperative comorbidities undergoing LATG and with postoperative abdominal complications was 57.4%.
Conclusion:Preoperative comorbidities are independent factors affecting abdominal complications of patients after LATG.