Springer Nature is making SARS-CoV-2 and COVID-19 research free. View research | View latest news | Sign up for updates

Major perioperative complications in laparoscopic spleen-preserving total gastrectomy for gastric cancer: perspectives from a high-volume center



Laparoscopic spleen-preserving total gastrectomy (LSPTG) for gastric cancer is only performed at a few specialized institutions and carries the risk of major perioperative complications (MPCs) that may require reoperation and impair recovery. However, the predictors of such events remain largely unknown.


Prospectively collected data from 325 consecutive patients undergoing LSPTG at a single institution from June 2011 to February 2014 were analyzed to determine the preoperative factors that correlated with MPCs. The rates of MPCs were assessed, and a score model was developed to identify preoperative variables associated with MPC.


Of the 325 LSPTG cases, the following types of MPCs were observed in 15 (4.6 %) patients: intraoperative splenic hilar vascular injury (n = 1); intraoperative splenic parenchymal injury (n = 5); intraoperative splenic infarction (n = 1); intraabdominal abscess that required radiological intervention [not under general anesthesia (n = 2)]; intra-abdominal bleeding that required reoperation under general anesthesia (n = 2); anastomotic hemorrhage that required reoperation under general anesthesia (n = 2); and death (n = 2). Three independent variables were correlated with MPCs in the multivariate analysis: body mass index (BMI) ≥25 kg/m2 (odds ratio [OR] 3.992, 95 % confidence interval [CI] 1.210–13.175), tumor located at the greater curvature (OR 3.922, 95 % CI 1.194–12.880), and No.10 LN metastases (OR 4.418, 95 % CI 1.250–13.770). A risk score consisting of one point for each preoperative risk factor (BMI ≥ 25 kg/m2 or tumor location in the greater curvature), resulting in an overall score of 0–2 points for each patient, predicted an increased risk of MPCs.


BMI, tumor location, and No.10 LN metastases were significantly associated with increased rates of MPCs. A simple, clinically relevant scoring system based on two preoperative variables was clinically useful in predicting MPC risk in patients undergoing LSPTG.

This is a preview of subscription content, log in to check access.

Fig. 1
Fig. 2
Fig. 3


  1. 1.

    Roder DM (2002) The epidemiology of gastric cancer. Gastric Cancer 5(Suppl. 1):5–11

  2. 2.

    Japanese Gastric Cancer Association (2011) Japanese gastric cancer treatment guidelines (2010, ver. 3). Gastric Cancer 14:113–123

  3. 3.

    Yu W, Choi GS, Chung HY et al (2006) Randomized clinical trial of splenectomy versus splenic preservation in patients with proximal gastric cancer. Br J Surg 93:559–563

  4. 4.

    Sano T, Yamamoto S, Sasako M et al (2002) Randomized controlled trial to evaluate splenectomy in total gastrectomy for proximal gastric carcinoma: Japan clinical oncology group study JCOG 0110-MF. Jpn J Clin Oncol 32:363–364

  5. 5.

    Shen JG, Cheong JH, Hyung WJ et al (2006) Adverse effect of splenectomy on recurrence in total gastrectomy cancer patients with perioperative transfusion. Am J Surg 192:301–305

  6. 6.

    Kim H-H, Han S-U, Kim M-C et al (2014) Long-term results of laparoscopic gastrectomy for gastric cancer: a large-scale case–control and case-matched Korean multicenter study. J Clin Oncol 32:627–633

  7. 7.

    Sobin LH, Gospodarowicz MK, Witterkind CH (2009) International Union Against Cancer (UICC) TNM classification of malignant tumors, 7th edn. Wiley-Blackwell, Oxford

  8. 8.

    Li P, Huang CM, Zheng CH et al (2014) Laparoscopic spleen-preserving splenic hilar lymphadenectomy in 108 consecutive patients with upper gastric cancer. World J Gastroenterol 20:11376–11383

  9. 9.

    Huang CM, Chen QY, Lin JX et al (2014) Laparoscopic spleen-preserving no. 10 lymph node dissection for advanced proximal gastric cancer using a left approach. Ann Surg Oncol 21:2051

  10. 10.

    Jia-Bin W, Chang-Ming H, Chao-Hui Z et al (2012) Laparoscopic spleen-preserving no. 10 lymph node dissection for advanced proximal gastric cancer in left approach: a new operation procedure. World J Surg Oncol 10:241

  11. 11.

    Huang C-M, Chen Q-Y, Lin J-X et al (2014) Huang’s three-step maneuver for laparoscopic spleen-preserving no. 10 lymph node dissection for advanced proximal gastric cancer. Chin J Cancer Res 26:208–210

  12. 12.

    Jin S, Hyung WJ, Li C et al (2009) The effect of spleen-preserving lymphadenectomy on surgical outcomes of locally advanced proximal gastric cancer. J Surg Oncol 99:275–280

  13. 13.

    Marrelli D, Pedrazzani C, Neri A et al (2007) Complications after extended (D2) and superextended (D3) lymphadenectomy for gastric cancer: analysis of potential risk factors. Ann Surg Oncol 14:25–33

  14. 14.

    Derogar M, Sadr-Azodi O, Lagergren P et al (2014) Splenic injury during resection for esophageal cancer : risk factors and consequences. Ann Surg 00:1–6

  15. 15.

    Dindo D, Demartines N, Clavien PA (2004) Classification of surgical complications: a new proposal with evaluation in a cohort of 6336 patients and results of a survey. Ann Surg 240:205–213

  16. 16.

    Weber SM, Cho C, Merchant N et al (2009) Laparoscopic left pancreatectomy: complication risk score correlates with morbidity and risk for pancreatic fistula. Ann Surg Oncol 16:2825–2833

  17. 17.

    Gervaz P, Bandiera-Clerc C, Buchs NC et al (2012) Scoring system to predict the risk of surgical-site infection after colorectal resection. Br J Surg 99:589–595

  18. 18.

    DeMaria EJ, Portenier D, Wolfe L (2007) Obesity surgery mortality risk score: proposal for a clinically useful score to predict mortality risk in patients undergoing gastric bypass. Surg Obes Relat Dis 3:134–140

  19. 19.

    Ajani JA, Bentrem DJ, Besh S et al (2013) Gastric cancer, version 2.2013: featured updates to the NCCN guidelines. J Natl Compr Cancer Netw 11:531–546

  20. 20.

    Okines A, Verheij M, Allum W et al (2010) Gastric cancer: ESMO clinical practice guidelines for diagnosis, treatment and follow-up. Ann Oncol 21(Suppl 5):v50–v54

  21. 21.

    Okajima K, Isozaki H (1995) Splenectomy for treatment of gastric cancer: Japanese experience. World J Surg 19:537–540

  22. 22.

    Otsuji E, Yamaguchi T, Sawai K et al (1999) Total gastrectomy with simultaneous pancreaticosplenectomy or splenectomy in patients with advanced gastric carcinoma. Br J Cancer 79:1789–1793

  23. 23.

    Kitamura K, Nishida S, Ichikawa D et al (1999) No survival benefit from combined pancreaticosplenectomy and total gastrectomy for gastric cancer. Br J Surg 86:119–122

  24. 24.

    Lee KY, Noh SH, Hyung WJ et al (2001) Impact of splenectomy for lymph node dissection on long-term surgical outcome in gastric cancer. Ann Surg Oncol 8:402–406

  25. 25.

    Kitano S, Iso Y, Moriyama M et al (1994) Laparoscopy assisted Billroth I gastrectomy. Surg Laparosc Endosc 4:146–148

  26. 26.

    Swanstrom LL, Pennings JL (1995) Laparoscopic control of short gastric vessels. J Am Coll Surg 181:347–351

  27. 27.

    Lee M-S, Lee J-H, Park DJ et al (2013) Comparison of short- and long-term outcomes of laparoscopic-assisted total gastrectomy and open total gastrectomy in gastric cancer patients. Surg Endosc 27:2598–2605

  28. 28.

    Jeong O, Jung MR, Kim GY et al (2013) Comparison of short-term surgical outcomes between laparoscopic and open total gastrectomy for gastric carcinoma: case–control study using propensity score matching method. J Am Coll Surg 216:184–191

  29. 29.

    Lee J-H, Ahn S-H, Park DJ et al (2012) Laparoscopic total gastrectomy with D2 lymphadenectomy for advanced gastric cancer. World J Surg 36:2394–2399

  30. 30.

    Sakuramoto S, Kikuchi S, Futawatari N et al (2009) Laparoscopy-assisted pancreas- and spleen-preserving total gastrectomy for gastric cancer as compared with open total gastrectomy. Surg Endosc 23:2416–2423

  31. 31.

    Hyung WJ, Lim JS, Song J et al (2008) Laparoscopic spleen-preserving splenic hilar lymph node dissection during total gastrectomy for gastric cancer. J Am Coll Surg 207:e6–e11

  32. 32.

    Hur H, Jeon HM, Kim W et al (2008) Laparoscopic pancreas- and spleen-preserving D2 lymph node dissection in advanced (cT2) upper-third gastric cancer. J Surg Oncol 97:169–172

  33. 33.

    Tanimura S, Higashino M, Fukunaga Y et al (2007) Laparoscopic gastrectomy with regional lymph node dissection for upper gastric cancer. Br J Surg 94:204–207

  34. 34.

    Shinohara T, Kanaya S, Taniguchi K et al (2009) Laparoscopic total gastrectomy with D2 lymph node dissection for gastric cancer. Arch Surg 144:1138–1142

  35. 35.

    Okabe H, Obama K, Kan T et al (2010) Medial approach for laparoscopic total gastrectomy with splenic lymph node dissection. J Am Coll Surg 211:e1–e6

  36. 36.

    Son T, Lee JH, Kim YM et al (2014) Robotic spleen-preserving total gastrectomy for gastric cancer: comparison with conventional laparoscopic procedure. Surg Endosc 28:2606–2615

  37. 37.

    Kawamura Y, Satoh S, Suda K et al (2014) Critical factors that influence the early outcome of laparoscopic total gastrectomy. Gastric Cancer. doi:10.1007/s10120-014-0392-9

  38. 38.

    Kunisaki C, Makino H, Takagawa R et al (2009) Predictive factors for surgical complications of laparoscopy assisted distal gastrectomy for gastric cancer. Surg Endosc 23:2085–2093

  39. 39.

    Ryu KW, Kim Y-W, Lee JH et al (2008) Surgical complications and the risk factors of laparoscopy-assisted distal gastrectomy in early gastric cancer. Ann Surg Oncol 15:1625–1631

  40. 40.

    Jiang X, Hiki N, Nunobe S et al (2011) Postoperative outcomes and complications after laparoscopy-assisted pylorus-preserving gastrectomy for early gastric cancer. Ann Surg 253:928–933

  41. 41.

    Kim MC, Kim W, Kim HH et al (2008) Risk factors associated with complication following laparoscopy-assisted gastrectomy for gastric cancer: a large-scale Korean multicenter study. Ann Surg Oncol 15:2692–2700

Download references


This work was supported by the National Key Clinical Specialty Discipline Construction Program of China (No. [2012]649) and Key Projects of Science and Technology Plan of Fujian Province (No. 2014Y0025).


J.L. and C.M.H. designed the study; J.L., C.H.Z., P.L., J.W.X., J.B.W., and J.X.L. collected the data. All the authors participated in interpreting the data, drafting the article, critically revising the paper for content, and providing final approval of the version submitted for publication. All the authors have seen, approved, and are completely familiar with the contents of the manuscript. All the authors are responsible for the accuracy of the manuscript, including the statistical calculations. No author has any financial conflicts of interest.

Author information

Correspondence to Chang-ming Huang.

Rights and permissions

Reprints and Permissions

About this article

Verify currency and authenticity via CrossMark

Cite this article

Lu, J., Huang, C., Zheng, C. et al. Major perioperative complications in laparoscopic spleen-preserving total gastrectomy for gastric cancer: perspectives from a high-volume center. Surg Endosc 30, 1034–1042 (2016).

Download citation


  • Major complications
  • Laparoscopic spleen-preserving total gastrectomy
  • Scoring system
  • Gastric cancer