ABSTRACT
Objective:To compare surgery-related indicators, patient recovery status, perioperative complications and risk factors affecting the occurrence of postoperative grade Ⅲ or higher complications in patients undergoing laparoscopic gastric mesenchymal tumor surgery with different visceral fat areas.Methods:Clinical data of 116 patients with gastric interstitial tumor in Shaanxi Provincial People′s Hospital from April 2014 to June 2020 were retrospectively analyzed, including 44 male patients and 72 female patients, with patient aged from 25 to 88 years old and the mean age was (61.8±10.7) years, including 54 patients in the high VFA group and 62 patients in the low VFA group. SPSS 23.0 was used for statistical analysis, and t-test and χ2 test were applied to compare and analyze the patients′ surgery-related indexes, postoperative recovery status, complications within 30 d after surgery and differences in Clavien-Dindo classification of complications, while univariate and multifactorial analyses were used to study the factors affecting the occurrence of postoperative grade Ⅲ or higher complications. Results:Patients in the high VFA group had a higher body mass index than in the low VFA group, and the difference was statistically significant ( t=4.48, P<0.001); patients in the high VFA group had longer operative time ( t=2.88, P=0.005), more intraoperative bleeding ( t=2.17, P=0.032), longer period of fasting ( t=2.73, P=0.008), longer time for defecation ( t=4.46, P<0.001) and bowel movement ( t=4.62, P<0.001), and longer postoperative hospital stay ( t=3.43) compared with those in the low VFA group ( t=2.73, P=0.001), prolonged defecation ( t=4.46), prolonged bowel movement ( t=4.62), and prolonged postoperative hospitalization ( t=3.43), with statistically significant differences ( P<0.05); the incidence of postoperative complications was significantly higher in the high VFA group (31.4%) compared with the low VFA group (14.5%) ( χ2=4.78, P=0.029); among them, the incidence of postoperative pulmonary infection was significantly higher in patients in the high VFA group (12.9%) compared with those in the low VFA group (1.6%), and the difference between them was statistically significant ( χ2=4.16, P<0.05); while the differences in postoperative incision-related complications, anastomotic fistula, lower limb venous thrombosis, and intestinal obstruction were not statistically significant ( P>0.05). The incidence of postoperative complications above grade Ⅲ of the Clavien-Dindo complication classification was significantly higher in patients in the high VFA group (16.7%) compared with those in the low VFA group (4.8%), and the difference between the two was statistically significant ( χ2=4.35, P<0.05); univariate analysis revealed that operative time ≥300 min and increased VFA were the risk factors for postoperative grade Ⅲ or higher complications, while VFA was not an independent risk factor. Conclusion:Larger visceral fat area increases the difficulty of laparoscopic gastric mesenchymal tumor surgery operation, and also affects patients′ postoperative recovery, leading to increased postoperative complications, but VFA is not an independent risk factor affecting the occurrence of postoperative grade Ⅲ or higher complications in patients with gastric mesenchymal tumor.
ABSTRACT
Objective:To investigate the risk factors affecting the occurrence of perioperative complications in patients with locally progressive gastric cancer undergoing radical gastric cancer treatment.Methods:The clinical data of 129 patients with locally progressive gastric cancer from January 2017 to December 2019 in Shaanxi Provincial People′s Hospital were retrospectively analyzed, including 98 males and 31 females, with an age ranged from 27 to 79 years and a mean age of (60.61±10.00) years. The postoperative complications of 129 patients with gastric cancer were firstly counted, and then the relationship between clinical data such as patients′ general condition, intraoperative status and pathological indexes and the occurrence of perioperative complications was analyzed by using univariate analysis, and significant factors were included in the logistic regression model for multifactor analysis to study the independent risk factors for the occurrence of perioperative complications.Results:Of the 129 patients, 25 cases (19.38%) had postoperative complications, including 10 cases (7.75%) with Clavien-Dindo classification combined with grade Ⅲ or higher complications. The results of univariate analysis suggested ACCI score >4 (30.76% vs 68.00%, χ2=11.86, P=0.001), body mass index ≥25 kg/m 2 (24.03% vs 60.00%, χ2=12.18, P=0.001), and preoperative hypoproteinemia (17.30% vs 36.00%, χ2=4.25, P=0.039), vascular cancer embolism (14.42% vs 40.00%, χ2=7.70, P=0.006), operative time ≥ 400 min (26.92% vs 52.00%, χ2=5.84, P=0.016), intraoperative bleeding ≥ 400 mL (13.46% vs 44.00%, χ2=12.03, P=0.001) were risk factors for the development of perioperative complications in patients with locally progressive gastric cancer. Multifactorial analysis showed that ACCI score >4, body mass index ≥25 kg/m 2, preoperative hypoproteinemia, vascular cancer embolism, and intraoperative bleeding ≥400 mL were independent risk factors for the occurrence of perioperative complications in patients with locally progressive gastric cancer ( P<0.05). Conclusions:The occurrence of perioperative complications in locally progressive gastric cancer hands was closely associated with ACCI score, body mass index, preoperative hypoproteinemia, vascular cancer embolism and intraoperative bleeding. ACCI score is expected to be a predictor of the occurrence of perioperative complications in patients with locally progressive gastric cancer.