Influence Of Body Configuration On The Short-term Therapeutic Effects Of Laparoscopic Distal Gastrectomy:A Multicenter Retrospective Study

Objective: To investigate the influence of body configuration on the short-term therapeutic effects and the risk factors of perioperative complication of laparoscopic radical distal gastrectomy.Methods: The retrospective cohort study was conducted.The clinicopathological data of 506 patients with gastric cancer who underwent laparoscopic radical distal gastrectomy+ D2 lymph nodes dissection in the 8 clinical centers between March 2016 and November 2018 were collected.Abdominal shape related data including the maximum thickness of subcutaneous fat at the level of umbilicus(which was defined as USCF),the maximum vertical distance between the anterior abdominal skin and the back skin at the level of the umbilicus(which was defined as UAPD)and the maximum horizontal distance of a plane at a right angle to UAPD(which was defined as UTD),the maximum vertical distance between the anterior abdominal skin and the back skin at the level of the xiphoid bone(which was defined as XAPD)and the maximum horizontal distance of a plane at a right angle to XAPD(which was defined as XTD),the vertical distance between the anterior abdominal skin and the root of celiac artery(which was defined as CAD)and that of a horizontal plane at a right angle to CAD(which was defined as CATD)were measured using preoperative CT scans.And we calculated the relationship between these data and clinicopathological factors using logistic regression and linear regression.Results: All the patients underwent successful operation,without perioperative death.Of 506 patients,328 were male,178 were female,age ranged from 24 to 85(average 60)years.Perioperative complication occurred in 93 cases(18.38%),including 11 cases the Clavien-Dindo grade more than three.Cases with operation time,perioperative bleeding,number of lymph nodes dissection were respectively(233±44)minutes,(102±86)mL,34±13.Cases with time to anal exsufflation,time for postoperative fluid diet intake,time for postoperative semi-fluid diet intake,duration of postoperative hospital stay were respectively(3.6±1.5)days,(5.8±3.3)days,(8.3±3.8)days,(12.2±5.7)days.Multivariate logistic regression analysis showed that age(OR:1.033,95%CI:1.011~1.057,P<0.05),BMI(OR:1.118,95%CI:1.025~1.219,P < 0.05),serum albumin(OR:0.937,95% CI:0.887~0.990,P<0.05)were independent risk factors of perioperative complication.Linear regression showed that the distance between the anterior abdominal skin and the root of celiac artery(CAD)associated with bleeding in operation(RC:6.776,P<0.05)and the number of lymph nodes dissection(RC:-0.841,P<0.05).And The thickness of subcutaneous fat at the level of umbilicus(USCF)associated with time to postoperative anal exsufflation(RC:0.170,P<0.05),time for initial fluid diet intake(RC:0.365,P<0.05),time of duration of postoperative hospital stay(RC:0.636,P<0.05).Conclusions: Abdominal configuration can influence intraoperative situation and postoperative recovery of laparoscopic distal gastrectomy with D2 lymph nodes dissection,but it cannot increase risks of perioperative complication.Age,BMI and preoperative serum albumin are independent related factors affecting perioperative complications of laparoscopic distal gastrectomy.