Risk factors of complications after laparoseopic gastrectomy: a Logistic analysis / 中华消化外科杂志

ABSTRACT

ObjectiveTo analyze the risk factors of complications after laparoscopic gastrectomy.Methods The clinical data of 76 patients who received laparoscopic gastrectomy at the Tenth Hospital of Tangji University from April 2009 to July 2011 were retrospectively analyzed.All patients were divided into complication group (13patients) and non-complication group (63 patients).Seventeen variables,including gender,age,abdominal surgery history,comorbidities (cardiovascular disease,chronic obstructive pulmonary disease,diabetes mellitus,anemia,hypoproteinemia,pyloric obstruction),palliative operation,operative data ( operation time,blood loss,method of alimentary tract reconstruction),postoperative TNM staging,vascular or nerve invasion and number of lymph nodes dissected were analyzed by using the univariate and Logistic regression analysis to screen out the risk factors of postoperative complications.All data were analyzed using the t test or chi-square test.ResultsThere were 67 patients received laparoscopic curative gastrectomy and 9 received laparoscopic palliative gastrectomy.Sixty-three patients received distal gastrectomy ( including 49 received BillrothⅠgastrectomy and 14 received Billroth Ⅱ gastrectomy) and 13 patients received total gastrectomy + Roux-en-Y esophagojejunostomy).The mean operation time,blood loss,number of lymph nodes dissected were ( 263 ± 72) minutes,( 200 ± 191 ) ml and 17 ±8,respectively.There were 25 patients in TNM stage Ⅰ,18 in stage Ⅱ,27 in stage Ⅲ and 6 in stage Ⅳ.The incidence of complications was high in the old patients,but there was no effect of gender and age on the incidence of complications ( x2 =0.68,2.32,P ＞ 0.05 ).The operation time of the complication group was longer than that of non-complication group,but no significant difference was observed ( t =1.44,P ＞ 0.05 ).Preoperative comobidities (cardiovascular disease,chronic obstructive pulmonary disease,diabetes mellitus,anemia,hypoproteinemia,pyloric obstruction),blood loss and number of lymph node disseeted were not the risk factors of postoperative complications ( x2 =3.20,0.58,0.13,0.26,0.01,0.19,t =0.15,0.83,P ＞ 0.05).The results of multivariate Logistic regression analysis showed that Billroth Ⅱ alimentary tract reconstruction,more comorbidites,and advanced TNM stage were correlated with postoperative complications ( OR =5.54,7.02,2.33,P ＜0.05 ).The accuracy rate of multivariate Logistic regression analysis was 8 i.6％.Conclusion Billroth Ⅱ alimentary tract reconstruction,more comorbidities,and advanced TNM stage are the independent risk factors of complicatioas after laparoscopic gastrectomy.