title: Risk factors and learning curve associated with postoperative morbidity of laparoscopic total gastrectomy for gastric carcinoma.
abstract: BACKGROUND
  Laparoscopic total gastrectomy (LTG) is a challenging surgical procedure that has substantial technical difficulties and complications. In this study, we investigated risk factors for morbidity and mortality after LTG, and the learning curve associated with postoperative morbidity.
  
  
  METHODS
  Prospectively constructed data of 203 patients undergoing LTG between 2004 and 2013 were retrospectively reviewed. The multivariate logistic regression model was used to analyze risk factors for postoperative morbidity. The Cumulative Sum (CUSUM) technique was used to assess the learning curve.
  
  
  RESULTS
  Postoperative morbidity and mortality after LTG was 18.7 and 1.5 %, respectively. Of 38 patients with postoperative morbidity, 7 (3.4 %) were managed with reoperation, 8 (4.0 %) with radiologic or endoscopic intervention, and 23 (11.3 %) with a conservative treatment. Of local complications, gastrointestinal bleeding was the most common (12 patients), followed by anastomosis leakage (9 patients) and intra-abdominal abscess (9 patients). Respiratory complication was the most common of the systemic complications. There were 17 cases (8.4 %) of complications exceeding grade III severity, of which anastomosis leakage was the most common. CUSUM analysis showed that postoperative morbidity reached a plateau after around 45 cases. Univariate and multivariate analyses revealed that old age (over 65 years of age) and surgical experience (<45 cases) were independent factors for postoperative morbidity after LTG.
  
  
  CONCLUSIONS
  LTG is a feasible technique with acceptable morbidity and mortality. However, substantial surgical experience is of most importance to reduce postoperative morbidity and mortality.
authors.affiliation: Department of Surgery, Chonnam National University Hwasun Hospital, Hwasun-gun, Jeollanam-do, South Korea, surgeonjeong@gmail.com.
authors.forename: Oh
authors.initials: O
authors.lastname: Jeong
authors.forename: Seong Yeop
authors.initials: SY
authors.lastname: Ryu
authors.forename: Won Yong
authors.initials: WY
authors.lastname: Choi
authors.forename: Zhengri
authors.initials: Z
authors.lastname: Piao
authors.forename: Young Kyu
authors.initials: YK
authors.lastname: Park
mesh_terms: D005260:Female; D005500:Follow-Up Studies; D005743:Gastrectomy; D005773:Gastroscopy; D006801:Humans; D010535:Laparoscopy; D059032:Learning Curve; D008297:Male; D008875:Middle Aged; D009017:Morbidity; D009367:Neoplasm Staging; D011183:Postoperative Complications; D011379:Prognosis; D011446:Prospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D013274:Stomach Neoplasms / Q000401:mortality / Q000473:pathology / Q000601:surgery*