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

Abstract

Background

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.

Methods

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.

Results

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.

Conclusions

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.

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Acknowledgments

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).

Disclosures

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.

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Correspondence to Chang-ming Huang.

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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). https://doi.org/10.1007/s00464-015-4291-x

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Keywords

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