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Risk factors affecting unplanned reoperation after laparoscopic gastrectomy for gastric cancer: experience from a high-volume center

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Abstract

Background

To evaluate the risk factors affecting unplanned reoperation (URO) after laparoscopic gastrectomy (LAG) for gastric cancer (GC) and establish a model to predict URO preoperatively.

Study design

Between May 2007 and December 2014, we prospectively collected and retrospectively analyzed the data of 2608 GC patients who underwent LAG. Among them, 2580 patients not requiring an URO were defined as the Non-URO group, and 28 patients requiring an URO were defined as the URO group. Univariate, multivariate, and bootstrap analyses were performed to determine the independent predictors for URO, and a nomogram was constructed to preoperatively predict the rate of URO after LAG.

Results

Of the 2608 patients, the URO rate was 1.1% (28/2608) within the 30-day hospitalization. The mean URO time interval to first operation was 5.6 ± 5.5 (0.10–18.5) days. The main causes requiring URO were intraabdominal bleeding (57.1%), anastomotic bleeding (17.9%), anastomotic leakage (7.1%), and intraabdominal infection (7.1%). Compared to the Non-URO group, the URO group had a significantly longer hospital stay (p < 0.001) and significantly higher hospital fees (p < 0.001). The morbidity rate was 39.2% in the URO group and 14.5% in the non-URO group (p = 0.001), and mortality was 3.6% in the URO group and 0.2% in the non-URO group (p = 0.063). Multivariate analysis using bootstrap method revealed that age >70 years (odds ratio (OR) = 2.232, 95% confidence interval (CI) = 1.023–4.491, p = 0.028), male gender (OR = 32.983, 95% CI 1.405–25.343 × 106, p = 0.027), and body mass index (BMI) > 25 kg/m2 (OR = 2.550, 95% CI 1.017–5.398, p = 0.012) were independent risk factors for URO. A multivariable nomogram model for predicting URO exhibited a strong optimism-adjusted discrimination (concordance index, 0.687). No significant correlation was noted between the URO rate and operative period by Spearman analysis (r = 0.012, p = 0.548).

Conclusions

Age > 70 years, Male, and BMI > 25 kg/m2 were independent risk factors for URO. Based on the three risk factors, we developed a simple and practical nomogram to predict URO preoperatively, which might aid surgeons in reducing the URO rate when planning to perform LAG for GC.

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References

  1. Kitano S, Iso Y, Moriyama M, Sugimachi K (1994) Laparoscopy-assisted billroth I gastrectomy. Surg Laparosc Endosc 4:146–148

    CAS  PubMed  Google Scholar 

  2. Shinohara T, Satoh S, Kanaya S, Ishida Y, Taniguchi K, Isogaki J, Inaba K, Yanaga K, Uyama I (2013) Laparoscopic versus open D2 gastrectomy for advanced gastric cancer: a retrospective cohort study. Surg Endosc 27:286–294

    Article  PubMed  Google Scholar 

  3. Kelly KJ, Selby L, Chou JF, Dukleska K, Capanu M, Coit DG, Brennan MF, Strong VE (2015) Laparoscopic versus open gastrectomy for gastric adenocarcinoma in the west: a case-control study. Ann Surg Oncol 22:3590–3596

    Article  PubMed  PubMed Central  Google Scholar 

  4. Lee JH, Lee CM, Son SY, Ahn SH, Park do J, Kim HH (2014) Laparoscopic versus open gastrectomy for gastric cancer: long-term oncologic results. Surgery 155 154–164

    Article  PubMed  Google Scholar 

  5. Kim HH, Han SU, Kim MC, Hyung WJ, Kim W, Lee HJ, Ryu SW, Cho GS, Song KY, Ryu SY (2014) Long-term results of laparoscopic gastrectomy for gastric cancer: a large-scale case-control and case-matched Korean multicenter study. J Clin Oncol 32:627–633

    Article  PubMed  Google Scholar 

  6. Kunisaki C, Makino H, Takagawa R, Sato K, Kawamata M, Kanazawa A, Yamamoto N, Nagano Y, Fujii S, Ono HA, Akiyama H, Shimada H (2009) Predictive factors for surgical complications of laparoscopy-assisted distal gastrectomy for gastric cancer. Surg Endosc 23:2085–2093

    Article  PubMed  Google Scholar 

  7. Lee JH, Park DJ, Kim HH, Lee HJ, Yang HK (2012) Comparison of complications after laparoscopy-assisted distal gastrectomy and open distal gastrectomy for gastric cancer using the Clavien-Dindo classification. Surg Endosc 26:1287–1295

    Article  PubMed  Google Scholar 

  8. Birkmeyer JD, Hamby LS, Birkmeyer CM, Decker MV, Karon NM, Dow RW (2001) Is unplanned return to the operating room a useful quality indicator in general surgery? Arch Surg 136:405–411

    Article  CAS  PubMed  Google Scholar 

  9. Kroon HM, Breslau PJ, Lardenoye JW (2007) Can the incidence of unplanned reoperations be used as an indicator of quality of care in surgery? Am J Med Qual 22:198–202

    Article  PubMed  Google Scholar 

  10. Rama-Maceiras P, Rey-Rilo T, Moreno-Lopez E, Molins-Gauna N, Sanduende-Otero Y, Pensado-Castiñeiras A (2011) Unplanned surgical reoperations in a tertiary hospital: perioperative mortality and associated risk factors. Eur J Anaesthesiol 28:10–15

    Article  PubMed  Google Scholar 

  11. Sah BK, Chen MM, Yan M, Zhu ZG (2010) Reoperation for early postoperative complications after gastric cancer surgery in a Chinese hospital. World J Gastroenterol 16:98–103

    PubMed  PubMed Central  Google Scholar 

  12. Washington K (2010) 7th edition of the AJCC cancer staging manual: stomach. Ann Surg Oncol 17:3077–3079

    Article  PubMed  Google Scholar 

  13. Nakajima T (2002) Gastric cancer treatment guidelines in Japan. Gastric Cancer 5:1–5

    Article  PubMed  Google Scholar 

  14. Japanese Gastric Cancer Association (2011) Japanese gastric cancer treatment guidelines 2010 (ver. 3). Gastric Cancer 14:113–123

    Article  Google Scholar 

  15. Dindo D, Demartines N, Clavien PA (2004) Classification of surgical complications: a new proposal with evaluation in a cohort of 6336 patients and results of a survey. Ann Surg 240:205–213

    Article  PubMed  PubMed Central  Google Scholar 

  16. Kim W, Song KY, Lee HJ, Han SU, Hyung WJ, Cho GS (2008) The impact of comorbidity on surgical outcomes in laparoscopy-assisted distal gastrectomy: a retrospective analysis of multicenter results. Ann Surg 248:793–799

    Article  PubMed  Google Scholar 

  17. WHO (1998) Guidelines for controlling and monitoring the tobacco epidemic. World Health Organization, Geneva

    Google Scholar 

  18. Weimann A, Braga M, Harsanyi L, Laviano A, Ljungqvist O, Soeters P, DGEM (German Society for Nutritional Medicine), Jauch KW, Kemen M, Hiesmayr JM, Horbach T, Kuse ER, Vestweber KH ESPEN (European Society for Parenteral and Enteral Nutrition) (2006) ESPEN guidelines on enteral nutrition: surgery including organ transplantation. Clin Nutr 25: 224–244

    Article  CAS  PubMed  Google Scholar 

  19. Fukuda Y, Yamamoto K, Hirao M, Nishikawa K, Maeda S, Haraguchi N, Miyake M, Hama N, Miyamoto A, Ikeda M, Nakamori S, Sekimoto M, Fujitani K, Tsujinaka T (2015) Prevalence of malnutrition among gastric cancer patients undergoing gastrectomy and optimal preoperative nutritional support for preventing surgical site infections. Ann Surg Oncol 22:778–785

    Article  Google Scholar 

  20. WHO (2000) International obesity task force: the Asia–Pacific perspective: redefining obesity and its treatment. Health Communications, Melbourne

    Google Scholar 

  21. Huang CM, Zheng CH, Li P, Xie JW (2015) Laparoscopic gastrectomy for gastric cancer: surgical technique and lymphadenectomy. Springer, Netherlands

    Book  Google Scholar 

  22. Kim MC, Kim W, Kim HH, Ryu SW, Ryu SY, Song KY, Lee HJ, Cho GS, Han SU, Hyung WJ (2008) Risk factors associated with complication following laparoscopy-assisted gastrectomy for gastric cancer: a large-scale Korean multicenter study. Korean Laparoscopic Gastrointestinal Surgery Study (KLASS) Group. Ann Surg Oncol 15:2692–2700

    Article  PubMed  Google Scholar 

  23. Yi HW, Kim SM, Kim SH, Shim JH, Choi MG, Lee JH, Noh JH, Sohn TS, Bae JM, Kim S (2013) Complications leading reoperation after gastrectomy in patients with gastric cancer: frequency, type, and potential causes. J Gastric Cancer 13:242–246

    Article  PubMed  PubMed Central  Google Scholar 

  24. Oh SJ, Choi WB, Song J, Hyung WJ, Choi SH, Noh SH (2009) Complications requiring reoperation after gastrectomy for gastric cancer: 17 years experience in a single institute. J Gastrointest Surg 13:239–245

    Article  PubMed  Google Scholar 

  25. Park JY, Kim YW, Eom BW, Yoon HM, Lee JH, Ryu KW, Cho SJ, Lee JY, Kim CG, Choi IJ (2014) Unique patterns and proper management of postgastrectomy bleeding in patients with gastric cancer. Surgery 155:1023–1029

    Article  PubMed  Google Scholar 

  26. Deguchi Y, Fukagawa T, Morita S, Ohashi M, Saka M, Katai H (2012) Identification of risk factors for esophagojejunal anastomotic leakage after gastric surgery. World J Surg 36:1617–1622

    Article  PubMed  Google Scholar 

  27. de Manzoni, F. Roviello, W. Siquini (eds) (2012) Surgery in the multimodal management of gastric cancer. Springer, Milan

    Google Scholar 

  28. Nagasako Y, Satoh S, Isogaki J, Inaba K, Taniguchi K, Uyama I (2012) Impact of anastomotic complications on outcome after laparoscopic gastrectomy for early gastric cancer. Br J Surg 99:849–854

    Article  CAS  PubMed  Google Scholar 

  29. Worrell S, Mumtaz S, Tsuboi K, Lee TH, Mittal SK (2010) Anastomotic complications associated with stapled versus hand-sewn anastomosis. J Surg Res 161:9–12

    Article  PubMed  Google Scholar 

  30. Tanizawa Y, Bando E, Kawamura T, Tokunaga M, Ono H, Terashima M (2010) Early postoperative anastomotic hemorrhage after gastrectomy for gastric cancer. Gastric Cancer 13:50–57

    Article  PubMed  Google Scholar 

  31. Kim MG, Kim KC, Kim BS, Kim TH, Kim HS, Yook JH, Kim BS (2011) A totally laparoscopic distal gastrectomy can be an effective way of performing laparoscopic gastrectomy in obese patients (body mass index ≥ 30). World J Surg 35:1327–1332

    Article  PubMed  Google Scholar 

  32. Ojima T, Iwahashi M, Nakamori M, Nakamura M, Naka T, Ishida K, Ueda K, Katsuda M, Iida T, Tsuji T, Yamaue H (2009) Influence of overweight on patients with gastric cancer after undergoing curative gastrectomy: an analysis of 689 consecutive cases managed by a single center. Arch Surg 144:351–358

    Article  PubMed  Google Scholar 

  33. House MG, Fong Y, Arnaoutakis DJ, Sharma R, Winston CB, Protic M, Gonen M, Olson SH, Kurtz RC, Brennan MF, Allen PJ (2008) Preoperative predictors for complications after pancreaticoduodenectomy: impact of BMI and body fat distribution. J Gastrointest Surg 12:270–278

    Article  PubMed  Google Scholar 

  34. Bickenbach KA, Denton B, Gonen M, Brennan MF, Coit DG, Strong VE (2013) Impact of obesity on perioperative complications and long-term survival of patients with gastric cancer. Ann Surg Oncol 20(3):780–787

    Article  PubMed  Google Scholar 

  35. Pata G, Solaini L, Roncali S, Pasini M, Ragni F (2013) Impact of obesity on early surgical and oncologic outcomes after total gastrectomy with “over-D1” lymphadenectomy for gastric cancer. World J Surg 37:1072–1081

    Article  PubMed  Google Scholar 

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Acknowledgements

This study was financially supported by the National Key Clinical Specialty Discipline Construction program of China (No. [2012]649), the Key Projects of Science and Technology Plan of Fujian Province (No. 2014Y0025), and Fund of Fujian Province science and technology innovation talents. The authors are thankful to Fujian Medical University Union Hospital for the management of our gastric cancer patient database.

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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

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

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  1. Ping Li
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Correspondence to Chang-Ming Huang.

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

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Li, P., Huang, CM., Tu, RH. et al. Risk factors affecting unplanned reoperation after laparoscopic gastrectomy for gastric cancer: experience from a high-volume center. Surg Endosc 31, 3922–3931 (2017). https://doi.org/10.1007/s00464-017-5423-2

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