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Complications and failure to rescue following laparoscopic or open gastrectomy for gastric cancer: a propensity-matched analysis

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Abstract

Background

To investigate the incidence of and factors associated with postoperative complications and failure to rescue following laparoscopic and open gastrectomy for gastric cancer.

Study design

We analyzed the records of 4124 patients who underwent a laparoscopic or open gastrectomy for gastric cancer. One-to-one propensity score matching was performed to compare the difference between the two groups.

Results

A total of 4124 patients were included in the study, 627 of whom (15.2 %) developed postoperative complications. Postoperative deaths occurred in 23 (0.6 %) patients with serious complications. In the propensity score matching analysis with 1361 pairs, no significant differences in the rates of overall complications (14.2 vs. 16.5 %, p = 0.093) were observed between laparoscopic and open gastrectomy group. In-hospital mortality decreased in patients who underwent laparoscopic gastrectomy compared to patients who underwent open gastrectomy (0.3 vs. 1.2 %, p = 0.004). Failure to rescue rates were lower in patients who underwent laparoscopic gastrectomy (2.1 vs. 7.6 %, p = 0.008). Multivariate analysis showed that older age, tumor location, TNM stage classification, extent of gastric resection, operative time and intra-operative blood loss were adverse risk factors for postoperative complications. Laparoscopic gastrectomy was found to be a protective factor for failure to rescue. Complications associated with failure to rescue included abdominal bleeding, anastomotic leakage and cardiac events. In-hospital mortality increased as the number of complications per patient increased.

Conclusions

Assuming equal competence with open and laparoscopic approaches of a surgeon, the proportion of patients with postoperative complications were similar among those who underwent laparoscopic gastrectomy compared to patients who underwent open gastrectomy. However, when complications occurred, patients with open gastrectomy were more likely to die.

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Acknowledgments

The authors are thankful to Fujian Medical University Union Hospital for their management of our gastric cancer patient database.

Funding

This study was funded by the National Key Clinical Specialty Discipline Construction program of China (No. [2012]649) and the Key Projects of Science and Technology Plan of Fujian Province (No. 2014Y0025).

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Authors and Affiliations

  1. Department of Gastric Surgery, Fujian Medical University Union Hospital, No. 29 Xinquan Road, Fuzhou, 350001, Fujian Province, China

    Ru-Hong Tu, Jian-Xian Lin, Chao-Hui Zheng, Ping Li, Jian-Wei Xie, Jia-Bin Wang, Jun Lu, Qi-Yue Chen, Long-Long Cao, Mi Lin & Chang-Ming Huang

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  1. Ru-Hong Tu
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Correspondence to Chang-Ming Huang.

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Ru-Hong Tu, Jian-Xian Lin, Chao-Hui Zheng, Ping Li, Jian-Wei Xie, Jia-Bin Wang, Jun Lu, Qi-Yue Chen, Long-Long Cao, Mi Lin and Chang-Ming Huang have no conflicts of interest or financial ties to disclose.

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Tu, RH., Lin, JX., Zheng, CH. et al. Complications and failure to rescue following laparoscopic or open gastrectomy for gastric cancer: a propensity-matched analysis. Surg Endosc 31, 2325–2337 (2017). https://doi.org/10.1007/s00464-016-5235-9

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