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Risk Factors and Learning Curve Associated with Postoperative Morbidity of Laparoscopic Total Gastrectomy for Gastric Carcinoma

  • Gastrointestinal Oncology
  • Published:
Annals of Surgical Oncology Aims and scope Submit manuscript

Abstract

Background

Laparoscopic total gastrectomy (LTG) is a challenging surgical procedure that has substantial technical difficulties and complications. In this study, we investigated risk factors for morbidity and mortality after LTG, and the learning curve associated with postoperative morbidity.

Methods

Prospectively constructed data of 203 patients undergoing LTG between 2004 and 2013 were retrospectively reviewed. The multivariate logistic regression model was used to analyze risk factors for postoperative morbidity. The Cumulative Sum (CUSUM) technique was used to assess the learning curve.

Results

Postoperative morbidity and mortality after LTG was 18.7 and 1.5 %, respectively. Of 38 patients with postoperative morbidity, 7 (3.4 %) were managed with reoperation, 8 (4.0 %) with radiologic or endoscopic intervention, and 23 (11.3 %) with a conservative treatment. Of local complications, gastrointestinal bleeding was the most common (12 patients), followed by anastomosis leakage (9 patients) and intra-abdominal abscess (9 patients). Respiratory complication was the most common of the systemic complications. There were 17 cases (8.4 %) of complications exceeding grade III severity, of which anastomosis leakage was the most common. CUSUM analysis showed that postoperative morbidity reached a plateau after around 45 cases. Univariate and multivariate analyses revealed that old age (over 65 years of age) and surgical experience (<45 cases) were independent factors for postoperative morbidity after LTG.

Conclusion

LTG is a feasible technique with acceptable morbidity and mortality. However, substantial surgical experience is of most importance to reduce postoperative morbidity and mortality.

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Acknowledgment

We deeply appreciate Drs. HS Kim and MR Jung for their kind assistance with collecting and interpreting the data.

Conflict of interest

Oh Jeong, Seong Yeop Ryu, Won Yong Choi, Zhengri Piao, and Young Kyu Park declare that they have no proprietary, commercial, or financial interests that could be construed to have inappropriately influenced this study.

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Authors and Affiliations

  1. Department of Surgery, Chonnam National University Hwasun Hospital, Hwasun-gun, Jeollanam-do, South Korea

    Oh Jeong MD, Seong Yeop Ryu MD, PhD, Zhengri Piao MD & Young Kyu Park MD, PhD

  2. Center for Creative Biomedical Scientists, Chonnam National University, Gwangju, South Korea

    Zhengri Piao MD & Young Kyu Park MD, PhD

  3. Department of Surgery, Dongguk University Ilsan Hospital, Seoul, South Korea

    Won Yong Choi MD

Authors
  1. Oh Jeong MD
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  2. Seong Yeop Ryu MD, PhD
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  3. Won Yong Choi MD
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  4. Zhengri Piao MD
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  5. Young Kyu Park MD, PhD
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Corresponding author

Correspondence to Seong Yeop Ryu MD, PhD.

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Jeong, O., Ryu, S.Y., Choi, W.Y. et al. Risk Factors and Learning Curve Associated with Postoperative Morbidity of Laparoscopic Total Gastrectomy for Gastric Carcinoma. Ann Surg Oncol 21, 2994–3001 (2014). https://doi.org/10.1245/s10434-014-3666-x

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  • DOI: https://doi.org/10.1245/s10434-014-3666-x

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