Risk Factors Associated with Complication Following Laparoscopy-Assisted Gastrectomy for Gastric Cancer: A Large-Scale Korean Multicenter Study
- Alternative Author(s)
- Ryu, Seung Wan
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- Background: The aim of this multicenter retrospective study was to establish background
data for future randomized clinical trial comparing open and laparoscopy-assisted gastrectomies
(LAGs). We sought to evaluate the technical feasibility of LAG by determining the
morbidity and mortality and identifying corresponding predictive factors.
Patients and Methods: A retrospective multicenter study was carried out in Korea on 1,485
patients in who, LAG had been attempted for gastric cancer under the care of ten surgeons, at
ten institutions, during the period spanning May 1998 to December 2005. Patient characteristics,
operative outcomes, and postoperative morbidities and mortalities were analyzed.
Results: Overall morbidity and mortality rates were 14.0% and 0.6%, respectively. Complications
included: wound problem (4.2%, n = 62), intraluminal bleeding (1.3%, n = 20),
intra-abdominal abscess or fluid collection (1.3%, n = 19), anastomotic leakage (1.3%,
n = 18), and intra-abdominal bleeding (1.3%, n = 18). By using multivariate analysis we
found that the two most important risk factors associated with postoperative complications
were presence of comorbidity in the patient and lack of experience on the part of the surgeon.
Conclusion: LAG is a technically feasible, safe, and effective method for treating patients
with gastric cancer. Extra caution in patients with comorbidities, and dedication to improving
surgical proficiency in LAG, may decrease the risk of complications. Through this study, we
have established the inclusion criteria for LAG. For our multicenter, prospective, randomized
trials (NCT00452751), potential patients should have an American Society of Anesthesiology(ASA) score of less than 3, and surgeons performing the procedures should have experience
with more than 50 cases of LAG.
Key Words: Gastric cancer—Laparoscopy-assisted gastrectomy—Lymph node dissection—
Postoperative morbidity—Risk factor.
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