The Impact Of The Number Of Lymph Node Dissection On Short-term Complications After Laparoscopic Distal Gastrectomy

Background: Gastric cancer has become the third-largest cancer in the world,with a high incidence in Western Europe,Eastern Asia,and other countries.Gastric cancer is a common malignant tumor,and the current treatment includes surgery and comprehensive treatment.Lymph node dissection is the key to the surgical treatment of gastric cancer.In order to improve the accuracy of p TNM staging,the 2021 guidelines for gastric cancer diagnosis and treatment of the Chinese Society of Clinical Oncology(CSCO)recommend that each case be evaluated at least at 16 lymph nodes,and if you want to get a more accurate evaluation,it is better to clear more than 30 lymph nodes.However,there are not enough studies to explore the relationship between the number of lymph node dissections and short-term postoperative complications of gastric cancer.The purpose of this study was to investigate the effect of the number of lymph node dissections on shortterm complications after laparoscopic distal gastrectomy.Methods: The clinical data of 209 patients were collected in Dalian central hospital from August 2019 to December 2022,all patients were treated with laparoscopic distal gastrectomy.The effect of the number of lymph node dissections on the short-term complications after laparoscopic distal gastrectomy was retrospectively analyzed.SPSS20.0 software was used to statistical analysis,P<0.05 was considered statistically significant.Results: Through univariate analysis,we found that short-term complications after laparoscopic distal gastrectomy was related to the length of stay(OR=1.086,95%CI=1.027-1.148,P=0.004)、N stage(OR=0.193,95%CI=0.038-0.987,P=0.048)、operation time(OR=1.015,95% CI=1.006-1.023,P=0.001)、the number of lymph node dissection(OR=1.300,95% CI=1.185-1.427,P=0.000)、 previous surgical history(OR=4.266,95% CI=1.033-17.233,P=0.045).Through multivariate analysis,we found that short-term complications after laparoscopic distal gastrectomy was related to the length of stay(OR=1.078,95% CI=1.026-1.133,P=0.003)、previous surgical history(OR=4.383,95% CI=1.385-13.872,P=0.000)、operation time(OR=1.014,95%CI=1.006-1.022,P=0.000)、the number of lymph node dissection(OR=1.250,95%CI=1.165-1.314,P=0.000).The area under the curve calculated by the ROC curve showed that when the number of lymph nodes dissected was 30(sensitivity was 83.30%,specificity was 83.20%),it had a better predictive effect on short-term complications after laparoscopic distal gastrectomy.The area under ROC curve(Aura under the curve,AUC)was 0.889.According to the number of lymph nodes,the patients were divided into two groups,we found that the incidence of short-term complications after laparoscopic distal gastrectomy was significantly higher in the group with more than 30 lymph node dissection than in the group with less than 30 lymph node dissection(P=0.000).Conclusion: Previous operation history、 operation time、the number of lymph node dissection、and the length of stay may be related to short-term complications after laparoscopic distal gastrectomy.The number of lymph node dissection is the most important factor of predicting short-term complications after laparoscopic distal gastrectomy.The number of lymph nodes dissected was more than 30 may increase the risk of short-term complications after laparoscopic distal gastrectomy.