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Comparison of the major postoperative complications between laparoscopic distal and total gastrectomies for gastric cancer using Clavien–Dindo classification

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Abstract

Background

Laparoscopy-assisted total gastrectomy (LATG) has not been as popular as laparoscopy-assisted distal gastrectomy (LADG) because of its undetermined safety and postoperative complications compared with LADG. Therefore, LATG requires further study.

Patients and methods

A total of 663 patients who underwent LADG or LATG for gastric cancer in a single institution from April 2004 to April 2014 were included. The clinicopathologic characteristics and risk factors related to major complications (Clavien–Dindo grade ≥ IIIa) were analyzed between the LADG (n = 569) and LATG groups (n = 94).

Results

The incidence of major postoperative complications was significantly higher for LATG (LADG vs. LATG: 8.1 vs. 18.1 %, P = 0.002). Although postoperative bleeding was not different between the groups (3.2 vs. 3.2 %, P = 0.991), the incidence of bowel leakage was significantly higher for LATG (2.6 vs. 6.8 %, P = 0.028). Leakage from the anastomosis site was more frequent following LATG (5.3 %) compared with LADG (0.5 %) (P < 0.001). Leakage from the duodenal stump tended to be more frequent, though not significant, for LADG (2.0 vs. 1.1 %, P = 0.602). Advanced gastric cancer, LATG, and longer operation time were significant factors that affected the incidence of postoperative complications in a univariate analysis. In multivariate analysis, there were no independent risk factors, but LATG was nearly a significant, independent risk factor (odds ratio 1.89; 95 % CI 0.965–3.71, P = 0.063).

Conclusion

More major complications were observed for LATG, particularly with esophagojejunostomy. These results show that LATG is more invasive than LADG in terms of the postoperative morbidity. More caution and experience are needed when performing LATG.

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Acknowledgments

This study was supported by a grant from the National R&D Program for Cancer Control, Ministry of Health & Welfare, Republic of Korea (1320270).

Disclosures

Drs. Dong Jin Kim, Jun Hyun Lee, and Wook Kim have no conflicts of interest or financial ties to disclose.

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Authors and Affiliations

  1. Division of GI Surgery, Department of Surgery, Yeouido St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, #62 Yeouido-dong, Yeongdeungpo-gu, Seoul, 150-713, Korea

    Dong Jin Kim & Wook Kim

  2. Department of Surgery, Bucheon St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Bucheon, Gyeonggi-do, Korea

    Jun Hyun Lee

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  1. Dong Jin Kim
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Correspondence to Wook Kim.

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Kim, D.J., Lee, J.H. & Kim, W. Comparison of the major postoperative complications between laparoscopic distal and total gastrectomies for gastric cancer using Clavien–Dindo classification. Surg Endosc 29, 3196–3204 (2015). https://doi.org/10.1007/s00464-014-4053-1

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  • DOI: https://doi.org/10.1007/s00464-014-4053-1

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