Journal List > J Korean Surg Soc > v.79(5) > 1011183

TOOLS
Kim, Park, Chi, and Kim: Postoperative Complications of Laparoscopy-assisted Gastrectomy in Early Gastric Cancer: The Importance of Precise Preoperative Staging
Original Article
Journal of the Korean Surgical Society

Journal of the Korean Surgical Society 2010; 79(5): 340-348.

Published online: 12 November 2010

DOI: https://doi.org/10.4174/jkss.2010.79.5.340

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

Min-Kyoon Kim, M.D., Joong-Min Park, M.D., Kyong-Choun Chi, M.D., Chong-Suk Kim, M.D.1

Department of Surgery, Chung-Ang University College of Medicine, Seoul, Korea.

1Department of Surgery, Korea University College of Medicine, Seoul, Korea.

Corresponding author (jmpark@cau.ac.kr)

Received 6 May 2010       Accepted 7 July 2010

Copyright © 2010 The Korean Surgical Society

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.

Keywords: Laparoscopy-assisted gastrectomy, Complication, Risk factor, Lymph node metastasis

Figures and Tables

Fig. 1
Operative time according to the number of cases experienced.
jkss-79-340-g001
Table 1
Clinicopathological characteristics and surgical outcome (n=92)
jkss-79-340-i001

*BMI = body mass index; †LADG = laparoscopy-assisted distal gastrectomy; ‡LATG = laparoscopy-assisted total gastrectomy; Plus-minus values are standard deviation.

Table 2
Summary of complication cases (n=11)
jkss-79-340-i002

*DT = delirium tremens.

Table 3
Univariate analysis of risk factors for postoperative complications of laparoscopy-assisted gastrectomy
jkss-79-340-i003

*BMI = body mass index; †LN = lymph node; ‡REY = Rouxen-Y esophagojejunostomy; §EMR = endoscopic mucosal resection.

Table 4
Multivariate analysis of risk factors for postoperative complications of laparoscopy-assisted gastrectomy
jkss-79-340-i004

*CI = confidence interval; †OR = odds ratio; ‡BMI = body mass index; §LN = lymph node.

References

1. Fujiwara M, Kodera Y, Misawa K, Kinoshita M, Kinoshita T, Miura S, et al. Longterm outcomes of early-stage gastric carcinoma patients treated with laparoscopy-assisted surgery. J Am Coll Surg. 2008. 206:138–143.
2. Kitano S, Shiraishi N, Uyama I, Sugihara K, Tanigawa N. A multicenter study on oncologic outcome of laparoscopic gastrectomy for early cancer in Japan. Ann Surg. 2007. 245:68–72.
3. Hwang SH, Park DJ, Jee YS, Kim HH, Lee HJ, Yang HK, et al. Risk factors for operative complications in elderly patients during laparoscopy-assisted gastrectomy. J Am Coll Surg. 2009. 208:186–192.
4. Ryu KW, Kim YW, Lee JH, Nam BH, Kook MC, Choi IJ, et al. Surgical complications and the risk factors of laparoscopy-assisted distal gastrectomy in early gastric cancer. Ann Surg Oncol. 2008. 15:1625–1631.
5. Park JM, Jin SH, Lee SR, Kim H, Jung IH, Cho YK, et al. Complications with laparoscopically assisted gastrectomy: multivariate analysis of 300 consecutive cases. Surg Endosc. 2008. 22:2133–2139.
6. Japanese Gastric Cancer Association. Japanese Classification of Gastric Carcinoma - 2nd English Edition. Gastric Cancer. 1998. 1:10–24.
7. Sobin LH, Wittekind C. International Union against Cancer. TNM Classification of Malignant Tumours. 2002. 6th ed. New York: Wiley-Liss.
8. Noshiro H, Nagai E, Shimizu S, Uchiyama A, Tanaka M. Laparoscopically assisted distal gastrectomy with standard radical lymph node dissection for gastric cancer. Surg Endosc. 2005. 19:1592–1596.
9. Tanimura S, Higashino M, Fukunaga Y, Kishida S, Nishikawa M, Ogata A, et al. Laparoscopic distal gastrectomy with regional lymph node dissection for gastric cancer. Surg Endosc. 2005. 19:1177–1181.
10. Noshiro H, Shimizu S, Nagai E, Ohuchida K, Tanaka M. Laparoscopy-assisted distal gastrectomy for early gastric cancer: is it beneficial for patients of heavier weight? Ann Surg. 2003. 238:680–685.
11. Huscher CG, Mingoli A, Sgarzini G, Sansonetti A, Lirici MM, Napolitano C, et al. Videolaparoscopic total and subtotal gastrectomy with extended lymph node dissection for gastric cancer. Am J Surg. 2004. 188:728–735.
12. Kim W, Song KY, Lee HJ, Han SU, Hyung WJ, Cho GS. The impact of comorbidity on surgical outcomes in laparoscopy-assisted distal gastrectomy: a retrospective analysis of multicenter results. Ann Surg. 2008. 248:793–799.
13. Bo T, Zhihong P, Peiwu Y, Feng Q, Ziqiang W, Yan S, et al. General complications following laparoscopic-assisted gastrectomy and analysis of techniques to manage them. Surg Endosc. 2009. 23:1860–1865.
14. Pugliese R, Maggioni D, Sansonna F, Scandroglio I, Ferrari GC, Di Lernia S, et al. Total and subtotal laparoscopic gastrectomy for adenocarcinoma. Surg Endosc. 2007. 21:21–27.
15. Kitano S, Shiraishi N, Fujii K, Yasuda K, Inomata M, Adachi Y. A randomized controlled trial comparing open vs laparoscopy-assisted distal gastrectomy for the treatment of early gastric cancer: an interim report. Surgery. 2002. 131:S306–S311.
16. Choi JE, Jeong O, Yook JH, Kim KJ, Lim JT, Oh ST, et al. Morbidity of laparoscopic assisted gastrectomy for early gastric cancer. J Korean Gastric Cancer Assoc. 2007. 7:152–159.
17. Wei JM, Shiraishi N, Goto S, Yasuda K, Inomata M, Kitano S. Laparoscopy-assisted distal gastrectomy with D1+beta compared with D1+alpha lymph node dissection. Surg Endosc. 2008. 22:955–960.
18. Hyung WJ, Song C, Cheong JH, Choi SH, Noh SH. Factors influencing operation time of laparoscopy-assisted distal subtotal gastrectomy: analysis of consecutive 100 initial cases. Eur J Surg Oncol. 2007. 33:314–319.
19. Lee K, Park DJ, Choe G, Kim HH, Kim WH, Lee HS. Increased intratumoral lymphatic vessel density correlates with lymph node metastasis in early gastric carcinoma. Ann Surg Oncol. 2010. 17:73–80.
20. Lee SI, Choi YS, Park DJ, Kim HH, Yang HK, Kim MC. Comparative study of laparoscopy-assisted distal gastrectomy and open distal gastrectomy. J Am Coll Surg. 2006. 202:874–880.
21. Yakoub D, Athanasiou T, Tekkis P, Hanna GB. Laparoscopic assisted distal gastrectomy for early gastric cancer: is it an alternative to the open approach? Surg Oncol. 2009. 18:322–333.
22. Hwang SI, Kim HO, Yoo CH, Shin JH, Son BH. Laparoscopic-assisted distal gastrectomy versus open distal gastrectomy for advanced gastric cancer. Surg Endosc. 2009. 23:1252–1258.
23. Namieno T, Koito K, Hiigashi T, Takahashi M, Shimamura T, Yamashita K, et al. Endoscopic prediction of tumor depth of gastric carcinoma for assessing the indication of its limited resection. Oncol Rep. 2000. 7:57–61.
24. Chen CY, Hsu JS, Wu DC, Kang WY, Hsieh JS, Jaw TS, et al. Gastric cancer: preoperative local staging with 3D multi-detector row CT--correlation with surgical and histopathologic results. Radiology. 2007. 242:472–482.
25. Kumano S, Murakami T, Kim T, Hori M, Iannaccone R, Nakata S, et al. T staging of gastric cancer: role of multi-detector row CT. Radiology. 2005. 237:961–966.
26. Tsendsuren T, Jun SM, Mian XH. Usefulness of endoscopic ultrasonography in preoperative TNM staging of gastric cancer. World J Gastroenterol. 2006. 12:43–47.
27. Xi WD, Zhao C, Ren GS. Endoscopic ultrasonography in preoperative staging of gastric cancer: determination of tumor invasion depth, nodal involvement and surgical resectability. World J Gastroenterol. 2003. 9:254–257.
28. Jeong O, Ryu SY, Park YK. Accuracy of surgical diagnosis in detecting early gastric cancer and lymph node metastasis and its role in determining limited surgery. J Am Coll Surg. 2009. 209:302–307.
29. Hirasawa T, Gotoda T, Miyata S, Kato Y, Shimoda T, Taniguchi H, et al. Incidence of lymph node metastasis and the feasibility of endoscopic resection for undifferentiated-type early gastric cancer. Gastric Cancer. 2009. 12:148–152.
TOOLS
Similar articles