A Scoring System To Predict The Risk Of Postoperative Complications After Laparoscopic Gastrectomy For Gastriccancer Based On A Large-scale Retrospective Study

Objectives: To investigate the risk factors for postoperative complications following laparoscopic gastrectomy for gastric cancer and to use the risk factors to develop a predictive scoring system.Background: Few studies have been designed to develop scoring systems to predict complications after laparoscopic gastrectomy for gastric cancer.Methods: We analyzed records of 2170 patients who underwent a laparoscopic gastrectomy for gastric cancer. The clinicopathologic characteristics(including gender, age, BMI, previous abdominal surgery, Charlson co-morbidity score, hemoglobin level, albumin level, maximum ventilatory volume, tumor with pyloric obstruction, tumor with bleeding, tumor location, tumor diameter, T stage, N stage, TNM stage), intraoperative outcomes(including operative time, intraoperative blood loss, type of surgical resection, type of reconstruction, D1+ /D2 lymphadenectomy, numbers of resected LNs, and operative period), and postoperative complications were collected and summarized. A logistic regression model was used to identify the determinant variables and develop a predictive score.Results: There were 2170 patients, of whom 299(13.8%) developed overall complications and 78(3.6%) developed major complications. A multivariate analysis showed the following adverse risk factors for overall complications: age ≥65 years, BMI≥28 kg/m2, tumor with pyloric obstruction, tumor with bleeding and intraoperative blood loss ≥75 ml; age ≥65 years, a Charlson co-morbidity score ≥3, tumor with bleeding and intraoperative blood loss ≥75 ml were identified as independent risk factors for major complications. Based on these factors, the authors developed the following predictive score: low risk(no risk factors), intermediate risk(1 risk factor), and high risk(≥2 risk factors). The overall complication rates were 8.3%, 15.6% and 29.9% for the low-, intermediate-, and high-risk categories, respectively(P <0.001); the major complication rates in the 3 respective groups were 1.2%, 4.7% and 10.0%(P <0.001). The area under the ROC curve was 0.641(95%CI: 0.606 to 0.675) for the logistic regression model and 0.637(95%CI: 0.602 to 0.671) for the simplified score for overall complications. In addition, the area under the ROC curve was 0.715(95%CI: 0.658 to 0.772) for the logistic regression model and 0.707(95%CI: 0.650 to 0.764) for the simplified score for major complications.Conclusions: This simple scoring system could accurately predict the risk of postoperative complications after laparoscopic gastrectomy for gastric cancer. The score might be helpful in the selection of risk-adapted interventions to improve surgical safety.