Effect Of Laparoscopy-assisted Surgery On Prolonged Postoperative Ileus After Curative Gastrectomy And Its Risk Factors

Background: Postoperative ileus(POI)is a common gastrointestinal disorder after surgery,which characterized by nausea,vomiting,delaying in flatus and defecation,inability to tolerate oral diets.POI prolongs hospital stay,increases risk of postoperative complications,and increases costs,slows the patient's postoperative recovery.Because of its advantages of less trauma and faster postoperative rehabilitation,laparoscopic surgery gradually replaces open surgery as the preferred surgical method for the treatment of gastric cancer.However,few studies have investigated the postoperative ileus after laparoscopy-assisted radical gastrectomy.Methods: Part 1: we collected retrospectively the clinical data of patients undergoing elective radical gastrectomy from November 2014 to May 2015 in the First Affiliated Hospital of Wenzhou Medical University.The observed variables included gender,age,ASA score,history of previous abdominal surgery,Nutrition risk screening 2002,preoperative albumin,preoperative hemoglobin,Charlson comorbidity index,the duration of surgery,epidural anesthesia,type of resection,type of reconstruction,extent of resection and combined organ resection,TNM.Propensity-matching methods were used to match the traditional group with the laparoscopy-assisted group.After matching,the ?2test was used to investigate the effect of laparoscopy-assisted surgery on POI.Part 2: We collected prospectively the clinical data of gastric cancer patients undergoing elective laparoscopy-assisted radical gastrectomy between March 2016 and October 2017 in the Shanghai Tenth People's Hospital and the First Affiliated Hospital of Wenzhou Medical University.Observation variables included age,gender,history of previous abdominal surgery,body mass index,preoperative hemoglobin,preoperative albumin,Charlson comorbidity index,ASA score,preoperative grip force,6-m walking test,the duration of surgery,epidural anesthesia,estimated bleeding loss during surgery,TNM,type of resection,type of reconstruction,extent of resection and combined organ resection,perioperative blood transfusions,total postoperative total opioids,postoperative complications,postoperative hospital stay,and costs.Univariate and multivariate analysis were performed to evaluate the risk factors for POI.Results: Part 1: This study included 287 patients,54(18.8%)patients undergoing laparoscopy-assisted radical gastrectomy for gastric cancer.History of previous abdominal surgery(P=0.004),TNM staging(P=0.008),and the type of reconstruction(P=0.019)before matching were unevenly distributed in the laparoscopy-assisted group and the traditional group.Finally,45 pairs of patients completed the matching with previous abdominal history(P=1.000),TNM staging(P=0.960)and the type of reconstruction(P=0.567)evenly distributed after matching between the two groups.The incidence of POI in patients undergoing laparoscopy-assisted surgery was 17.8% which was significantly lower than 37.8% in the traditional group(P=0.034).Part 2: 15.4% of patients undergoing laparoscopy-assisted radical gastrectomy developed POI in the two hospitals.We divided all patients into POI group and non-POI group.The results showed that patients with POI had significantly higher risk of the incidence of postoperative complications(47.8% VS 24.6%,respectively,P=0.023),longer postoperative hospital stay(median 13 days vs 9 days,respectively,P=0.001),and higher costs(median ?69848.32 VS ?61844.28,respectively,P= 0.006)than those without POI.The duration of surgery ? 210 minutes(OR= 2.831,95% CI: 1.044-7.678,P=0.041),TNM=III(OR=2.806,95% CI: 1.088-7.240,P=0.033)and anemia(OR=3.410,95% CI: 1.244-9.343,P=0.017)were independent risk factors for POI after laparoscopy-assisted radical gastrectomy.Conclusions:1.Laparoscopy-assisted surgery can reduce the incidence of POI after radical gastrectomy.2.POI was common after laparoscopy-assisted curative gastrectomy for gastric cancer.The presence of POI increased the risk of postoperative complications,prolonged postoperative hospital stay and increased costs3.The duration of surgery?210 minutes,TNM=III and anemia were independent risk factors for POI after laparoscopy-assisted radical gastrectomy.For patients with anemia,advanced gastric cancer and long duration of surgery,attention should be paid to the recovery of intestinal function after surgery.