Impact Of Previous Abdominal Operations On The Outcome Of Laparoscopy-Assisted Radical Total Gastrectomy

Objective To explore the impact of previous abdominaloperations on the outcome of laparoscopy-assisted radical totalgastrectomy(LATG). Methods The clinical data of328patients with gastriccancer underwent LATG from January2008to December2010were analyzed.Among the patients,57cases with previous abdominal surgeries (PASgroup,13cases with previous gastrectomy,44cases with previous abdominalsurgeries except for previous gastrectomy);271cases without previousabdominal surgeries (NPAS group).The recovery and complications wereanalyzed between two groups. The risk factors that determinedpostoperative complications were investigated by univariate andmultivariate analysis. Results There were no significant differencesbetween the two groups in the mean number of removal lymph nodes(LNs)(30.2±10.5vs31.1±9.4).However, the mean number of removal LNs in thepatients with previous gastrectomy was significantly less than withprevious abdominal surgeries except for previous gastrectomy. There wereno significant differences in each station except for stations No.5and6.The operation time and the postoperative morbidity were significantlybetween two groups. however, no significant differences were observedbetween the two groups in terms of blood loss,blood transfusion,firstflatus time, time to resume soft diet，postoperative hospital stays，and conversion rate. By logistic regression analysis, it was revealed thatthere were three significant factors for postoperative complications suchas preoperative comorbidity, LN metastasis and the operation time. Whileprevious abdominal surgeries wasn’t independent risk factor affecting thepostoperative morbidity. Conclusions Previous abdominal surgeries should not be regarded as an absolute contrainditon for laparoscopy-assistedradical gastrectomy. Skilled laparoscopic technique does not affect theeffect of lymph node dissection and increase the conversion rate. previousabdominal surgeries prolonged operative time,but aren’t independentrisk facors for postoperative complications.