J Korean Surg Soc.  2010 Nov;79(5):340-348. 10.4174/jkss.2010.79.5.340.

Postoperative Complications of Laparoscopy-assisted Gastrectomy in Early Gastric Cancer: The Importance of Precise Preoperative Staging

• Kim MK
• Park JM
• Chi KC
• Kim CS

• KMID: 2212038
• DOI: http://doi.org/10.4174/jkss.2010.79.5.340

Abstract

PURPOSE
Although laparoscopy-assisted gastrectomy (LAG) has become a popular treatment option for early gastric cancer, information about postoperative complications is limited in the literature and their risk factors vary among investigators. We analyzed the complications and their risk factors of LAG.
METHODS
We performed LAGs in 92 gastric cancer patients from July 2006 to December 2009. LAG indication was gastric cancer preoperatively diagnosed as cT1N0. Clinical and operative data and perioperative complications were retrospectively reviewed. According to the surgical experience, cases were divided into early (1~40) and late (41~92) groups because operative times stabilized after the 40th case.
RESULTS
There were no open conversion or mortality cases. Complications occurred in 11 patients. Two of them were non-surgical complications: postoperative delirium and cerebral infarction. Surgical complications were ischemic necrosis of transverse colon, duodenal stump leakage, anastomotic bleeding, leakage and stenosis. Univariate analysis proved that lymph node metastasis, and comorbidities were related to complication rate (P=0.000, P=0.032). Multivariate analysis proved that lymph node metastasis was the most important risk factor of complication (P=0.001). Surgical experience was not related to complication rate (12.5% in early period and 11.5% in late period, P=1.000).
CONCLUSION
Complication rate of LAG was acceptable (11.9%). According to this study, unexpected lymph node metastasis is thought to be the most important risk factor for complications of LAG. Therefore, it is possible to accomplish lower complication rates in this procedure with careful patient selection through accurate preoperative evaluation.

Keyword

Laparoscopy-assisted gastrectomy; Complication; Risk factor; Lymph node metastasis

MeSH Terms

Anastomotic Leak
Cerebral Infarction
Colon, Transverse
Comorbidity
Constriction, Pathologic
Delirium
Gastrectomy
Hemorrhage
Humans
Lymph Nodes
Multivariate Analysis
Necrosis
Neoplasm Metastasis
Operative Time
Patient Selection
Postoperative Complications
Research Personnel
Retrospective Studies
Risk Factors
Stomach Neoplasms

Figure

• 

  Fig. 1 Operative time according to the number of cases experienced.

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