Abstract: Objective:To explore the effect of unplanned reoperation (URO) on clinical efficacy after radical resection of gastric cancer (GC), and its causes and risk factors analysis affecting URO.
Methods:The retrospective casecontrol study was conducted. The clinicopathological data of 4 124 patients who underwent radical resection of GC in the Union Hospital of Fujian Medical University between January 2005 and December 2014 were collected. The initial operation was open or laparoscopic radical resection of GC. Observation indicators: (1) initial operation situations, results of pathologic examination and followup situations; (2) postoperative recovery situations; (3) causes and time interval of URO after radical resection of GC; (4) univariate analysis affecting URO after radical resection of GC; (5) multivariate analysis affecting URO after radical resection of GC. Followup using outpatient examination, telephone interview and Wechat was performed to detect postoperative 30day recovery of patients. Measurement data with normal distribution were represented as ±s, and comparisons between groups were done using the independentsample t test. Count data and univariate analysis were done using the chisquare test or Fisher exact probability. Multivariate analysis was done using the logistic regression model.
Results:(1) Initial operation situations, results of pathologic examination and followup situations: ① Initial operation situations of 4 124 patients, 2 608 and 1 516 underwent respectively laparoscopic surgery and open surgery; 2 259 and 1 865 underwent respectively total gastrectomy and distal gastrectomy. ② Results of pathological examination of 4 124 patients: 883, 468, 959 and 1 814 were respectively in T1, T2, T3 and T4a stages; 1 414, 571, 683 and 1 456 were in N0, N1, N2 and N3 stages; 1 073, 825 and 2 226 were inⅠ,Ⅱ and Ⅲ stages. ③ All the 4 124 patients were followed up within 30 days after initial operation, with a followup rate of 100.000%(4 124/4 124), including 52 with URO and 4 072 without URO, with a early URO rate of 1.261%(52/4 124). (2) Postoperative recovery situations: of 4 072 patients without URO, 575 had postoperative complications, with an incidence of 14.121%(575/4 072); 17 died after operation, with a mortality of 0.417%(17/4 072), and duration of postoperative hospital stay was (14.0±9.0)days. Of 52 patients with URO, 23 had complications after reoperation, with an incidence of 44.231%(23/52); 6 died after reoperation, with a mortality of 11.538%(6/52), and duration of postoperative hospital stay was (28.0±13.0)days. There were statistically significant differences in above indicators between groups (x²=37.550, t=10.900, P<0.05). (3) Causes and time interval of URO after radical resection of GC: total time interval between initial operation and URO of 52 patients was (6.9±6.7)days. Causes of URO of 52 patients: 23 (2 deaths), 7, 6 (2 deaths), 5, 5 (1 death), 3, 2 and 1 (death) patients were respectively due to intraperitoneal hemorrhage, anastomotic bleeding, anastomotic leakage, intraabdominal infection, small bowel obstruction, dehiscence of abdominal incisions, enteric perforation and pancreatic fistula, and time intervals between initial operation and URO of them were respectively (3.9±3.8)days, (0.9±0.5)days, (7.9±4.7)days, (14.9±4.6)days, (16.4±9.9)days, (10.0±6.0)days, (6.7±5.2)days and 12.0 days. (4) Univariate analysis affecting URO after radical resection of GC: results showed that age, body mass index (BMI) and volume of intraoperative blood loss were risk factors affecting URO after radical resection of GC (x²=5.468, 7.589, 5.041, P<0.05). (5) Multivariate analysis affecting URO after radical resection of GC: results showed that age > 70 years old, BMI > 25 kg/m² and volume of intraoperative blood loss > 100 mL were independent risk factors affecting occurrence of URO after radical resection of GC (odds ratio=1.950, 2.288, 1.867; 95% confidence interval: 1.074-3.538, 1.230-4.257, 1.067-3.267, P<0.05).
Conclusions:URO can increase postoperative complications and mortality, and extend duration of hospital stay after radical resection of GC. Intraabdominal bleeding, anastomotic bleeding and anastomotic leakage are the main causes affecting occurrence of URO after radical resection of GC, and age > 70 years old, BMI > 25 kg/m² and volume of intraoperative blood loss > 100 mL are independent risk factors affecting occurrence of URO after radical resection of GC.