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| Risk factors analysis of intraoperative vascular injury during laparoscopic-assisted gastrectomy for gastric cancer |
| WU Jiaming ZHU Yi DOU Guangjian ZHOU Yuan LU Bohao CHEN Zhiheng PENG Yuping |
| Department of Gastrointestinal Surgery, the First Hospital of Jiaxing, Zhejiang Province, Jiaxing 314000, China |
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Abstract Objective To explore the risk factors of vascular injury in laparoscopic radical gastrectomy and its influence on postoperative recovery. Methods The clinical data of 136 consecutive patients with gastric cancer who underwent laparoscopic radical gastrectomy in Department of Gastrointestinal Surgery, the First Hospital of Jiaxing Zhejiang Province, from January 2015 to December 2017 were retrospectively analyzed. The risk factors of vascular injury and its effect on postoperative recovery were analyzed. Results Among the 136 patients, 84 patients were in the injured group and 52 patients were in the non-injured group. In the comparison study between the injured group and the non-injured group, age ＞ 55 years (OR = 2.304, 95%CI: 1.072-4.950, P ＜ 0.05), diameter of tumor＞3.5 cm (OR = 2.318, 95%CI: 1.027-5.232, P ＜ 0.05), lymph node metastasis (OR = 5.015, 95%CI: 1.348-18.656, P ＜ 0.05) were independent risk factors for intraoperative vascular injury. Compared with the non-injured group, the postoperative hospitalization days were significantly longer in the injured group (P ＜ 0.05), and the amount of blood loss was higher (P ＜ 0.01). Postoperative complications were more likely to occur when intraoperative blood loss was 200 mL or above (P ＜ 0.01). Conclusion Advanced age, large tumor and lymph node invasion are independent risk factors for vascular injury in laparoscopic radical gastrectomy. When vascular injury occurs during the operation, the postoperative hospitalization time is significantly prolonged, even affecting the occurrence of complications.
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[1] 陈万青，李贺，孙可欣，等.2014年中国恶性肿瘤发病和死亡分析[J].中华肿瘤杂志，2018，40（1）：5-13.
[2] Japanese Gastric Cancer Association. Japanese gastric cancer treatment guidelines [J]. Gastric Cancer，2017，20（1）：1-19.
[3] Hu YF，Huang CM，Sun YH，et al. Morbidity and Mortality of Laparoscopic Versus Open D2 Distal Gastrectomy for Advanced Gastric Cancer： A Randomized Controlled Trial [J]. J Clin Oncol，2016，34（12）：1350-1357.
[4] Zheng CH，Xu M，Huang CM，et al. Anatomy and influence of the splenic artery in laparoscopic spleen-preserving splenic lymphadenectomy [J]. World J Gastroenterol，2015，21（27）：8389-9837.
[5] Jung DH，Son SY，Park YS，et al. The learning curve associated with laparoscopic total gastrectomy [J]. Gastric Cancer，2016，19（1）：264-272.
[6] Japanese Gastric Cancer Association. Japanese gastric cancer treatment guidelines 2010（ver.3）[J]. Gastric Cancer，2011，14（2）：113-123.
[7] Katai H，Mizusawa J，Katayama H，et al. Short-term surgical outcomes from a phase Ⅲ study of laparoscopy-assisted versus open distal gastrectomy with nodal dissection for clinical stage IA/IB gastric cancer：Japan Clinical Oncology Group Study JCOG0912 [J]. Gastric Cancer，2017， 20（4）：699-708.
[8] Nam BH，Kim YW，Reim D，et al. Laparoscopy Assisted versus Open Distal Gastrectomy with D2 Lymph Node Dissection for Advanced Gastric Cancer：Design and Rationale of a Phase Ⅱ Randomized Controlled Multicenter Trial（COACT 1001）[J]. J Gastric Cancer，2013，13：164-171.
[9] Wang ZZ，Xing JD，Cai J，et al. Short-term surgical outcomes of laparoscopy-assisted versus open D2 distal gastrectomy for locally advanced gastric cancer in North China：a multicenter randomized controlled trial [J]. Surg Endosc，2019，33（1）：33-45.
[10] Kinoshita T，Shibasaki H，Enomoto N，et al. Laparoscopic splenichilar lymph node dissection for proximal gastric cancer using integrated three-dimensional anatomic simulation software [J]. Surg Endosc，2016，30（6）：2613-2619.
[11] Luo J，Zhu Y，Liu H，et al. Morbidity and mortality of elderly patients with advanced gastric cancer after laparoscopy-assisted or open distal gastrectomy：a randomized-controlled trial [J]. Gastroenterol Rep（Oxf），2018，6（4）：317-319.
[12] Zhao BC，Zhang JT，Mei D，et al. Does high body mass index negatively affect the surgical outcome and long-term survival of gastric cancer patients who underwent gastrectomy：a systematic review and meta-analysis [J]. Eur J Surg Oncol，2018，44（12）：1971-1981.
[13] Yoo CH，Kim HO，Hwang SI，et al. Short-term outcomes of laparoscopic-assisted distal gastrectomy for gastric cancer during a surgeon′s learning curve period [J]. Surg Endosc，2009，23（10）：2250-2257.
[14] Li ZY，Shan F，Ying XJ，et al. Laparoscopic versus open gastrectomy for elderly local advanced gastric cancer patients：study protocol of a phase II randomized controlled trial [J]. Cancer，2018，18（1）：1118.
[15] Kouzu K，Tsujimoto H，Hiraki S，et al. Efficacy of totally laparoscopic distal gastrectomy for gastric cancer in elderly patients [J]. Mol Clin Oncol，2016， 4（6）：976-982.
[16] Kim HS，Kim MG，Kim BS，et al. Analysis of predictive risk factors for postoperative complications of laparoscopy-assisted distal gastrectomy [J]. J Laparoendosc Adv Surg Tech A，2013，23（5）：425-430.
[17] Hamakawa T，Kurokawa Y，Mikami J，et al. Risk factors for postoperative complications after gastrectomy in gastric cancer patients with comorbidities [J]. Surg Today，2016，46（2）：224-228.
[18] Kim MC，Jung GJ，Kim HH，et al. Learning curve of laparoscopy-assisted distal gastrectomy with systemic lymphadenectomy for early gastric cancer [J]. World J Gastroenterol，2005，11（47）：7508-7511.
[19] Shi Y，Xu XH，Zhao YL，et al. Short-term surgical outcomes of a randomized controlled trial comparing laparoscopic versus open gastrectomy with D2 lymph node dissection for advanced gastric cancer [J]. Surg Endosc，2018，32（5）：2427-2433.
[20] Kang SY，Lee SY，Kim CY，et al. Comparison of Learning Curves and Clinical Outcomes between Laparoscopy-assisted Distal Gastrectomy and Open Distal Gastrectomy [J]. J Gastric Cancer，2010，10（4）：247-250. |
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