Analysis Of Postoperative Complications And Long-term Outcomes After Laparoscopy-assisted Distal Gastrectomy For Gastric Cancer

Objective Analyzing the post-operative complications and long-term outcomes in laparoscopy-assisted distal gastrectomy(LADG).Methods From January of 2004 to December of 2014,a series of 424 consecutive patients who received laparoscopiy-assisted distal gastrectomy in our center were included and studied.Both univariate and multivariate statistical analysis were made on aspects of clinical characteristics(gender,age,body mass index(BMI),history of previous abdominal surgery,comorbidity);operation(operation time,hemorrhage volume,combined surgery,period of surgery);method of operation(type of lymph node dissection,type of anastomosis);pathologic characteristics(pathological type,number of retrieved lymph nodes,number of metastatic lymph nodes,tumor size,tumor stage),post-operative complications and long-term outcomes.Median follow-up is 43 months.Results BMI,type of anastomosis,tumor size and status of lymphatic metastasis(N stage)are significant risk factors associated with post-operative complications.Binary logistic regression showed that BMI and type of anastomosis are independent risk factors of post-operative complications,their values are 3.109;3.597(B-Ⅱ vs B-Ⅰ),3.283(R-Y vs B-I)respectively.With regard to the follow-up after the surgeries,the number of mortality was50,among them,gastric cancer-related 29 cases,others 21 cases and the number of recurrence was 31,loss to follow-up 30 cases.In the analysis of long-term outcomes,the5-year overall survival rate was 84.2%,5-year disease free survival rate was 83.9%,respectively.Age,pathologic differentiation and tumor stage were independent risk factors for overall survival,hazard rate(HR)was 0.657;0.634;2.919(Ⅱ vs Ⅰ),16.302(Ⅲ vs Ⅰ)respectively.For disease-free survival,age,type of anasomosis and tumor stage wereindependent risk factors,hazard rate(HR)was 0.640;0.718;3.481(Ⅱ vs Ⅰ),18.387(Ⅲ vs Ⅰ)respectively.Conclusions LADG for gastic cancer is oncologically safe and the outcomes are comparable with precedent studies.BMI,type of anastomosis,tumor size and status of lymphatic metastasis(N stage)are significant risk factors associated with complications after LADG.Age,pathologic differentiation and tumor stage were independent risk factors for 5-year overall survival.Age,type of anasomosis and tumor stage were independent risk factors for 5-year disease-free survival.