Early unplanned reoperations after gastrectomy for gastric cancer are different between laparoscopic surgery and open surgery
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To compare the differences in occurrence rates, time intervals, main causes, and management strategies of early unplanned reoperations (EUROs) after gastrectomy for gastric cancer (GC) between laparoscopic and open surgery.
From Jan. 2005 to Dec. 2014, 2608 and 1516 patients underwent laparoscopic-assisted gastrectomy (LAG) and open gastrectomy (OG), respectively. Perioperative outcomes and risk factors for EURO were analyzed.
The overall EURO rate was 1.3%, and the rate in LAG and OG groups was 1.1% and 1.6%, respectively. The EURO rate after 24 h postoperatively was significantly lower in LAG group than in OG group (p = 0.019). No significant correlation was identified between laparoscopic surgery and EURO rate (p = 0.157); age > 70 (p = 0.028), body mass index (BMI) > 25 kg/m2 (p = 0.009), and estimated blood loss > 100 ml (p = 0.029) were independent risk factors for EURO. The main cause of EURO was intra-abdominal bleeding, anastomotic bleeding, and anastomotic leakage in LAG group; and intra-abdominal bleeding, anastomotic leakage, and intestinal obstruction in OG group. The proportion of patients with intra-abdominal bleeding requiring EURO was markedly higher in LAG group than in OG group (p = 0.043). Transverse mesocolonic vessels and spleen were the most common bleeding sites necessitating EURO in LAG and OG groups, respectively. Six of 28 (21.4%) patients with EUROs in LAG group underwent laparoscopic procedure (p = 0.025). Mortality in patients requiring EURO was 3.6% and 20.8% in LAG and OG groups, respectively (p = 0.084).
Compared to open surgery, laparoscopic surgery does not increase the incidence of EURO in patients undergoing gastrectomy for GC; however, laparoscopic surgery is associated with a lower EURO rate after 24 h postoperatively and a higher proportion of patients with intra-abdominal bleeding requiring EURO than open surgery. Effective and accurate intraoperative hemostasis for intra-abdominal vessels and anastomotic sites will help further reduce the incidence of EURO following LAG within 24 h postoperatively.
KeywordsGastric cancer Gastrectomy Minimally invasive surgery Reoperation Mortality
This work was supported by the Scientific and technological innovation joint capital projects of Fujian Province (No. 2016Y9031); the second batch of special support funds for Fujian Province innovation and entrepreneurship talents (No. 2016B013); Natural Science Foundation of Fujian Province (No. 2016J01463); Construction Project of Fujian Province Minimally Invasive Medical Center (No. 171); and Fujian science and technology innovation joint fund project (No. 2017Y9004).
Compliance with ethical standards
Drs. Ping Li, Jian-xian Lin, Ru-hong Tu, Jun Lu, Jian-wei Xie, Jia-bin Wang, Qi-yue Chen, Long–long Cao, Mi Lin, Ze-ning Huang, Ju-li Lin, Chao-hui Zheng, and Chang-ming Huang have no conflicts of interest or financial ties to disclose.
- 6.Kim W, Kim HH, Han SU, Kim MC, Hyung WJ, Ryu SW, Cho GS, Kim CY, Yang HK, Park DJ, Song KY, Lee SI, Ryu SY, Lee JH, Lee HJ; Korean Laparo-endoscopic Gastrointestinal Surgery Study (KLASS) Group (2016) Decreased morbidity of laparoscopic distal gastrectomy compared with open distal gastrectomy for stage I gastric cancer: short-term outcomes from a multicenter randomized controlled trial (KLASS-01).Ann Surg 263:28–35CrossRefGoogle Scholar
- 7.Hu Y, Huang C, Sun Y, Su X, Cao H, Hu J, Xue Y, Suo J, Tao K, He X, Wei H, Ying M, Hu W, Du X, Chen P, Liu H, Zheng C, Liu F, Yu J, Li Z, Zhao G, Chen X, Wang K, Li P, Xing J, Li G (2016) Morbidity and mortality of laparoscopic versus open D2 distal gastrectomy for advanced GC: a randomized controlled trial. J Clin Oncol 34:1350–1357CrossRefGoogle Scholar
- 10.Sah BK, Chen MM, Yan M, Zhu ZG (2010) Reoperation for early postoperative complications after GC surgery in a Chinese hospital. World J Gastroenterol 16:98–103Google Scholar
- 16.Kim MC, Kim W, Kim HH, Ryu SW, Ryu SY, Song KY, Lee HJ, Cho GS, Han SU, Hyung WJ. Korean Laparoscopic Gastrointestinal Surgery Study (KLASS) Group (2008) Risk factors associated with complication following laparoscopy-assisted gastrectomy for GC: a large-scale Korean multicenter study. Ann Surg Oncol 15:2692–2700CrossRefGoogle Scholar
- 17.Hu YF, Yu J, Zhang C, Wang YN, Cheng X, Huang F, Li GX (2010) Development and implementation of a clinical data mining system for gastric cancer surgery (in Chinese). Chin J Gastrointest Surg 13:510–515Google Scholar
- 28.Evans C, Galustian C, Kumar D, Hagger R, Melville DM, Bodman-Smith M, Jourdan I, Gudgeon AM, Dalgleish AG (2009) Impact of surgery on immunologic function: comparison between minimally invasive techniques and conventional laparotomy for surgical resection of colorectal tumors. Am J Surg 197:238–245CrossRefGoogle Scholar
- 29.Veenhof AA, Vlug MS, van der Pas MH, Sietses C, van der Peet DL, de Lange-de Klerk ES, Bonjer HJ, Bemelman WA, Cuesta MA (2012) Surgical stress response and postoperative immune function after laparoscopy or open surgery with fast track or standard perioperative care: a randomized trial. Ann Surg 255:216–221CrossRefGoogle Scholar