Copyright
©The Author(s) 2020.
World J Gastroenterol. Mar 21, 2020; 26(11): 1172-1184
Published online Mar 21, 2020. doi: 10.3748/wjg.v26.i11.1172
Published online Mar 21, 2020. doi: 10.3748/wjg.v26.i11.1172
Table 1 Patient backgrounds and surgical outcomes following minimally invasive gastrectomy at our institution, n = 1401
Clinicopathological characteristics | Surgical outcomes | ||
Age (yr) | 69 (24–93) | No. of operators (certified surgeon) | 33 (19) |
Gender (M:F) | 973:428 | Qualified:non-qualified surgeons | 925:476 |
Body mass index (kg/m2) | 22.3 (1 4.3–37.3) | Procedure (RG:LG) | 359:1042 |
ASA grade (1:2:3) | 500:733:168 | Type of resection (DG:PG:TG) | 993:89:319 |
History of laparotomy, n (%) | 263 (18.8) | Extent of lymphadenectomy (D1+:D2) | 767:634 |
Tumor size (mm) | 30 (0–180) | Splenectomy, n (%) | 40 (2.9) |
cT1 (1:2:3:4a) | 751:264:224:162 | Total operative time (min) | 348 (147–942) |
cN1 (−:+) | 1093:308 | Estimated blood loss (mL) | 30 (0–2150) |
cStage1 (I:IIA:IIB:III) | 939:76:154:232 | No. of dissected LNs | 35 (6–114) |
pT1 (1:2:3:4a) | 797:164:178:262 | Conversion to open procedure, n (%) | 1 (0.1) |
pN1 (0:1:2:3) | 949:174:137:141 | Reoperation rate, n (%) | 15 (1.1) |
pStage1 (I:II:III) | 856:280:265 | In-hospital mortality, n (%) | 4 (0.3) |
No. of metastatic LNs | 0 (0–63) | Morbidity, n (%) | 105 (7.5) |
Use of preoperative chemotherapy, n (%) | 120 (8.6) | Hospital stay following surgery (d) | 13 (2–195) |
Table 2 Risk factors for morbidity after minimally invasive gastrectomy, n = 1401
Factors | Univariate analysis, OR (95%CI) | P value | Multivariate analysis, OR (95%CI) | P value |
Non-robotic minimally invasive surgery | 2.438 (1.381–4.304) | 0.002 | 2.591 (1.418–4.717) | 0.002 |
Age ≥ 70 yr | 1.020 (0.706–1.474) | 0.920 | ||
Male | 2.277 (1.372–3.779) | 0.001 | 1.969 (1.142–3.390) | 0.015 |
Body mass index ≥ 23 kg/m2 | 1.138 (0.763–1.698) | 0.538 | ||
ASA score 2 or higher | 1.069 (0.703–1.625) | 0.832 | ||
cT21 or higher | 1.296 (0.870–1.930) | 0.222 | ||
cN1 positive | 1.183 (0.745–1.879) | 0.540 | ||
cStage II1 or higher | 1.649 (1.102–2.467) | 0.017 | 1.247 (0.809–1.922) | 0.318 |
Proximal or total gastrectomy | 1.847 (1.230–2.772) | 0.004 | 1.208 (0.753–1.937) | 0.433 |
D2 lymph node dissection | 1.204 (0.809–1.792) | 0.415 | ||
Splenectomy | 2.734 (1.179–6.339) | 0.026 | 1.360 (0.542–3.408) | 0.512 |
History of laparotomy | 1.083 (0.658–1.783) | 0.795 | ||
Operative time ≥ 360 min | 2.449 (1.613–3.718) | < 0.001 | 1.800 (1.098–2.952) | 0.020 |
Estimated blood loss ≥ 50 mL | 2.039 (1.367–3.042) | < 0.001 | 1.368 (0.873–2.143) | 0.209 |
Tumor size ≥ 30 mm | 1.119 (0.703–1.782) | 0.721 | ||
pT21 or higher | 1.378 (0.926–2.052) | 0.125 | ||
pN1 positive | 1.155 (0.761–1.753) | 0.516 | ||
pStage II 1 or higher | 1.471 (0.987–2.192) | 0.061 | ||
Use of neoadjuvant chemotherapy | 1.274 (0.662–2.452) | 0.467 | ||
Non-qualified surgeons | 1.148 (0.785–1.679) | 0.521 |
Table 3 Patient characteristics and clinicopathological features by each type of procedure
Entire cohort (n = 1401) | P value | SD | Propensity-score matched cohort (n = 708) | P value | SD | |||
RG (n = 359) | LG (n = 1042) | RG (n = 354) | LG (n = 354) | |||||
Age (yr) | 67 (30–89) | 70 (24–93) | < 0.001 | 0.24 | 67 (30–89) | 66 (24–90) | 0.315 | 0.10 |
Gender (M:F) | 233:126 | 740:302 | 0.033 | 0.12 | 230:124 | 230:124 | 1.000 | 0 |
Body mass index (kg/m2) | 22.9 (14.3–32.0) | 22.2 (14.5–37.3) | 0.021 | 0.12 | 22.8 (14.3–32.0) | 22.4 (14.9–37.3) | 0.752 | 0.03 |
ASA grade (1:2:3) | 160:168:31 | 340:565:137 | < 0.001 | 0.25 | 155:168:31 | 149:174:31 | 0.905 | 0.03 |
History of laparotomy, n (%) | 66 (18.4) | 197 (18.9) | 0.876 | 0.01 | 65 (18.4) | 59 (16.7) | 0.621 | 0.04 |
Tumor size (mm) | 30 (0–170) | 30 (0–180) | 0.013 | 0.14 | 30 (0–170) | 30 (0–180) | 0.208 | 0.09 |
cT1 (1:2:3:4a) | 198:75:56:30 | 553:189:168:132 | 0.131 | 0.04 | 195:74:55:30 | 204:70:48:32 | 0.834 | 0.05 |
cN1 (−:+) | 287:72 | 806:236 | 0.337 | 0.06 | 284:70 | 289:65 | 0.702 | 0.04 |
cStage1 (I:II:III) | 249:62:48 | 690:168:184 | 0.183 | 0.07 | 246:61:47 | 252:59:43 | 0.962 | 0.04 |
pT1 (1:2:3:4a) | 210:36:46:67 | 587:128:132:195 | 0.711 | 0.05 | 208:36:46:64 | 213:36:39:66 | 0.882 | 0.03 |
pN1 (0:1:2:3) | 249:47:24:39 | 700:127:113:102 | 0.145 | 0.05 | 246:46:24:38 | 244:48:18:44 | 0.72 | 0.01 |
pStage1 (I:II:III) | 221:80:58 | 635:200:207 | 0.200 | 0.01 | 219:78:57 | 224:71:59 | 0.823 | 0.03 |
No. of metastatic LNs | 0 (0–43) | 0 (0–63) | 0.385 | 0.03 | 0 (0–43) | 0 (0–37) | 0.819 | 0.02 |
Use of preoperative chemotherapy, n (%) | 19 (5.3) | 101 (9.7) | 0.011 | 0.17 | 19 (5.4) | 18 (5.1) | > 0.999 | 0.01 |
Type of resection (DG:PG:TG) | 250:42:67 | 743:47:252 | < 0.001 | 0.13 | 248:39:67 | 252:33:69 | 0.778 | 0.01 |
Extent of lymphadenectomy (D1+:D2) | 178:181 | 589:453 | 0.023 | 0.14 | 175:179 | 175:179 | > 0.999 | 0 |
Splenectomy, n (%) | 6 (1.7) | 34 (3.3) | 0.142 | 0.11 | 6 (1.7) | 7 (2.0) | > 0.999 | 0.02 |
Table 4 Surgical outcomes and short-term postoperative courses
Entire cohort (n = 1401) | P value | Propensity-score matched cohort (n = 708) | P value | |||
RG (n = 359) | LG (n = 1042) | RG (n = 354) | LG (n = 354) | |||
No. of operators (qualified surgeon) | 8 (8) | 33 (14) | NA | 8 (8) | 33 (14) | NA |
Qualified:non-qualified surgeons | 359:0 | 572:475 | < 0.001 | 354:0 | 186:149 | < 0.001 |
Total operative time (min) | 360 (174–942) | 342 (147–937) | < 0.001 | 360 (174–942) | 347 (149–937) | 0.001 |
Console time (min) | 306 (136–860) | NA | NA | 307 (136–860) | NA | NA |
Estimated blood loss (mL) | 36 (0–935) | 29 (0–2150) | 0.007 | 37 (0–935) | 28 (0–2150) | 0.005 |
No. of dissected LNs | 37 (7–100) | 35 (6–114) | 0.058 | 37 (7–100) | 36 (6–108) | 0.807 |
Conversion to open procedure, n (%) | 0 (0) | 1 (0.1) | > 0.999 | 0 | 0 | > 0.999 |
Reoperation rate, n (%) | 4 (1.1) | 11 (1.1) | > 0.999 | 4 (1.1) | 6 (1.7) | 0.750 |
Hospital stay following surgery (d) | 12 (2–195) | 13 (3–177) | < 0.001 | 12 (2–195) | 13 (3–131) | 0.001 |
In-hospital mortality, n (%) | 2 (0.6) | 2 (0.3) | 0.578 | 2 (0.6) | 1 (0.3) | > 0.999 |
Table 5 Postoperative complications with a Clavien–Dindo grade of IIIa or higher, n (%)
Entire cohort (n = 1401) | P value | Propensity-score matched cohort (n = 708) | P value | |||
RG (n = 359) | LG (n = 1042) | RG (n = 354) | LG (n = 354) | |||
Morbidity | 13 (3.6) | 92 (8.8) | 0.002 | 13 (3.7) | 27 (7.6) | 0.033 |
Intra-abdominal infection | 9 (2.5) | 66 (6.3) | 0.005 | 9 (2.5) | 21 (5.9) | 0.038 |
Anastomotic leakage | 6 (1.7) | 22 (2.1) | 0.670 | 6 (1.7) | 7 (2.0) | > 0.999 |
Pancreatic fistula | 3 (0.8) | 28 (2.7) | 0.058 | 3 (0.8) | 9 (2.5) | 0.143 |
Intraperitoneal abscess | 0 (0) | 16 (1.5) | 0.017 | 0 (0) | 5 (1.4) | 0.062 |
Other local complications | 3 (0.8) | 14 (1.3) | 0.632 | 2 (0.6) | 4 (1.1) | 0.682 |
Intra-abdominal bleeding | 2 (0.6) | 4 (0.4) | > 0.999 | 1 (0.3) | 2 (0.6) | > 0.999 |
Bowel obstruction | 0 (0) | 7 (0.6) | 0.150 | 0 (0) | 0 (0) | > 0.999 |
Anastomotic stenosis | 1 (0.3) | 3 (0.3) | > 0.999 | 1 (0.3) | 2 (0.6) | > 0.999 |
Systemic complications | 1 (0.3) | 17 (1.6) | 0.091 | 1 (0.3) | 4 (1.1) | 0.369 |
Pneumonia | 0 (0) | 9 (0.9) | 0.256 | 0 (0) | 2 (0.6) | 0.499 |
Pulmonary embolism | 1 (0.3) | 2 (0.2) | 0.726 | 1 (0.3) | 0 (0) | > 0.999 |
Renal dysfunction | 0 (0) | 1 (0.1) | 0.573 | 0 (0) | 0 (0) | > 0.999 |
Cardiovascular disease | 0 (0) | 5 (0.5) | 0.337 | 0 (0) | 2 (0.6) | 0.499 |
Table 6 Risk factors for intra-abdominal infectious complications (propensity score-matched cohort, n = 708)
Factors | Univariate analysis, OR (95%CI) | P value | Multivariate analysis, OR (95%CI) | P value |
Non-robotic minimally invasive surgery | 2.333 (1.084–5.024) | 0.038 | 2.463 (1.070–5.682) | 0.034 |
Age ≥ 70 yr | 1.141 (0.546–2.388) | 0.849 | ||
Male | 4.852 (1.487–15.834) | 0.003 | 3.937 (1.157–13.333) | 0.028 |
Body mass index ≥ 23 kg/m2 | 1.064 (0.511–2.214) | > 0.999 | ||
ASA score 2 or higher | 1.135 (0.538–2.393) | 0.851 | ||
cStage II1 or more | 1.394 (0.651–2.982) | 0.416 | ||
Proximal or total gastrectomy | 2.513 (1.205–5.240) | 0.014 | 1.694 (0.722–3.974) | 0.226 |
D2 dissection | 1.023 (0.508–2.061) | > 0.999 | ||
Splenectomy | 1.579 (0.467–5.339) | 0.668 | ||
Operative time ≥ 360 min | 4.863 (1.963–12.048) | < 0.001 | 2.779 (1.003–7.701) | 0.049 |
Estimated blood loss ≥ 50 mL | 3.596 (1.682–7.687) | 0.001 | 2.204 (0.967–5.023) | 0.060 |
Tumor size ≥ 30 mm | 1.057 (0.508–2.201) | > 0.999 | ||
pStage II1 or more | 1.120 (0.531–2.363) | 0.848 | ||
Use of neoadjuvant chemotherapy | 1.599 (0.224–11.419) | 0.729 | ||
Non-qualified surgeons | 2.047 (1.018–4.118) | 0.045 | 1.852 (0.810–4.237) | 0.145 |
- Citation: Shibasaki S, Suda K, Nakauchi M, Nakamura K, Kikuchi K, Inaba K, Uyama I. Non-robotic minimally invasive gastrectomy as an independent risk factor for postoperative intra-abdominal infectious complications: A single-center, retrospective and propensity score-matched analysis. World J Gastroenterol 2020; 26(11): 1172-1184
- URL: https://www.wjgnet.com/1007-9327/full/v26/i11/1172.htm
- DOI: https://dx.doi.org/10.3748/wjg.v26.i11.1172