Intraoperative Complications in Laparoscopy- assisted Distal Gastrectomy (LADG) for Gastric Cancer

ABSTRACT

PURPOSE: A laparoscopy-assisted distal gastrectomy (LADG) has recently become a viable alternative for the treatment of patients with early gastric cancer. Surgeons seeking to undertake, or currently practicing LADG, are concerned about the unpredictable intraoperative events that occur during a LADG. However, little information exists on the intraoperative complications during a LADG. The aims of this study were to investigate the intraoperative complications and identify the factors predictive of intraoperative bleeding during a laparoscopy-assisted distal gastrectomy (LADG), with a lymphadenectomy for gastric cancer greater than D1+beta. METHODS: Of the 219 patients, who underwent a laparoscopy- assisted gastrectomy for gastric cancer by a single surgeon, between April 2003 and January 2006, 128 were enrolled in this study. The operative procedure was divided into 5 steps. Various intraoperative complications, such as bleeding and perigastric organ injuries, occurring during the different operative steps were investigated by reviewing videotapes of the procedures. RESULTS: A total of 839 bleeding events were encountered during the procedure, with a mean of 6.6 per patient. The mean numbers of bleeding events during each step were significantly different, with greater numbers occurring during steps II and IV (P < 0.0001). A multiple logistical regression analysis identified male gender (P=0.002, odds ratio 3.870) and a higher body mass index (P=0.038, odds ratio 1.158) as independent predictors of higher intraoperative bleeding rates. CONCLUSION: Intraoperative bleeding was found to be the most common complication during a LADG for gastric cancer, with greater numbers of bleeding events occurring during steps II and IV. Gender and body mass index were independent covariates associated with the development of intraoperative bleeding during a LADG.