Abstract: Objective:To explore the risk factors of complications after laparoscopyassisted distal gastrectomy (LADG) for gastric cancer (GC).
Methods:The retrospective casecontrol study was conducted. The clinicopathological data of 488 GC patients who underwent LADG in the General Hospital of the Chinese People′s Liberation Army between January 2010 and May 2016 were collected. Observation indicators: (1) surgical and postoperative situations; (2) risk factors analysis of postoperative complications; (3) followup and survival situations. Followup using outpatient examination and telephone interview was performed to detect the postoperative survival of patients up to October, 2017. Measurement data with normal distribution were represented as ±s, and measurement data with skewed distribution were described as M (interquartile range).The univariate analysis was done using the chisquare test (count data), t test (measurement data with normal distrubution and homogeneity of variance) or t′ test (measurement data with normal distribution and heterogeneity of variance) and nonparametric test (measurement data with skewed distrubution). The multivariate analysis was done using the Logistic regression model.
Results:(1) Surgical and postoperative situations: all the 488 patients underwent successful surgery, including 7 with conversion to open surgery due to intraoperative bleeding and difficult surgery and 481 with LADG. The operation time and volume of intraoperative blood loss of 488 patients were (233± 71)minutes and 100 mL (100 mL). The postoperative complications occurred in 99 of 488 patients, some patients merged simultaneously multiple complications. The ClavienDindoⅠ, Ⅱ, Ⅲa, Ⅲb, Ⅳa, Ⅳb and Ⅴ complications were detected in 39, 26, 26, 6, 0, 0 and 2 patients, respectively. The top 3 postoperative complications were delayed gastric emptying (18 patients), intestinal obstruction (14 patients) and anastomotic fistula (14 patients). Cases with delayed gastric emptying, intestinal obstruction and anastomotic fistula were respectively 12, 12, 6 with the ClavienDindo classification <Ⅲa and 6, 2, 8 with the ClavienDindo classification≥Ⅲa. Of 99 patients with postoperative complications, 97 were improved by symptomatic treatment and 2 died. Duration of postoperative hospital stay was (13±12)days. (2) Risk factors analysis of postoperative complications: the results of univariate analysis showed that preoperative concomitant diseases and digestive tract reconstruction were the related factors affecting postoperative complications of patients undergoing LADG (X²=11.225, 6.581, P<0.05). The results of multivariate analysis showed that preoperative concomitant diseases and Billroth Ⅱ anastomosis were the independent risk factors affecting postoperative complications of patients undergoing LADG (Odds ratio=2.336, 2.630, 95% confidence interval: 1.475-3.687, 1.369-5.053, P<0.05). (3) Followup and survival situations: of 486 discharged patients, 380 were followed up for 2-89 months, with a median time of 42 months. During the followup, 289, 35, 48 and 8 patients had respectively tumorfree survival, tumor recurrence and/or metastasis, tumorrelated death and nontumorrelated death.
Conclusion:The anastomotic fistula is one of the common and severe complications after LADG, and preoperative concomitant diseases and Billroth Ⅱ anastomosis are the independent risk factors affecting postoperative complications of patients undergoing LADG.