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Erschienen in: Surgical Endoscopy 3/2016

01.03.2016

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

verfasst von: Jun Lu, Chang-ming Huang, Chao-hui Zheng, Ping Li, Jian-wei Xie, Jia-bin Wang, Jian-xian Lin, Qi-yue Chen, Long-long Cao, Mi Lin

Erschienen in: Surgical Endoscopy | Ausgabe 3/2016

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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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Metadaten
Titel
Major perioperative complications in laparoscopic spleen-preserving total gastrectomy for gastric cancer: perspectives from a high-volume center
verfasst von
Jun Lu
Chang-ming Huang
Chao-hui Zheng
Ping Li
Jian-wei Xie
Jia-bin Wang
Jian-xian Lin
Qi-yue Chen
Long-long Cao
Mi Lin
Publikationsdatum
01.03.2016
Verlag
Springer US
Erschienen in
Surgical Endoscopy / Ausgabe 3/2016
Print ISSN: 0930-2794
Elektronische ISSN: 1432-2218
DOI
https://doi.org/10.1007/s00464-015-4291-x

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