title: Major perioperative complications in laparoscopic spleen-preserving total gastrectomy for gastric cancer: perspectives from a high-volume center.
abstract: BACKGROUND
  Laparoscopic spleen-preserving total gastrectomy (LSPTG) for gastric cancer is only performed at a few specialized institutions and carries the risk of major perioperative complications (MPCs) that may require reoperation and impair recovery. However, the predictors of such events remain largely unknown.
  
  
  METHODS
  Prospectively collected data from 325 consecutive patients undergoing LSPTG at a single institution from June 2011 to February 2014 were analyzed to determine the preoperative factors that correlated with MPCs. The rates of MPCs were assessed, and a score model was developed to identify preoperative variables associated with MPC.
  
  
  RESULTS
  Of the 325 LSPTG cases, the following types of MPCs were observed in 15 (4.6%) patients: intraoperative splenic hilar vascular injury (n = 1); intraoperative splenic parenchymal injury (n = 5); intraoperative splenic infarction (n = 1); intraabdominal abscess that required radiological intervention [not under general anesthesia (n = 2)]; intra-abdominal bleeding that required reoperation under general anesthesia (n = 2); anastomotic hemorrhage that required reoperation under general anesthesia (n = 2); and death (n = 2). Three independent variables were correlated with MPCs in the multivariate analysis: body mass index (BMI) ≥25 kg/m(2) (odds ratio [OR] 3.992, 95% confidence interval [CI] 1.210-13.175), tumor located at the greater curvature (OR 3.922, 95% CI 1.194-12.880), and No.10 LN metastases (OR 4.418, 95 % CI 1.250-13.770). A risk score consisting of one point for each preoperative risk factor (BMI ≥ 25 kg/m(2) or tumor location in the greater curvature), resulting in an overall score of 0-2 points for each patient, predicted an increased risk of MPCs.
  
  
  CONCLUSIONS
  BMI, tumor location, and No.10 LN metastases were significantly associated with increased rates of MPCs. A simple, clinically relevant scoring system based on two preoperative variables was clinically useful in predicting MPC risk in patients undergoing LSPTG.
authors.affiliation: Department of Gastric Surgery, Fujian Medical University Union Hospital, Fuzhou, China.
authors.forename: Jun
authors.initials: J
authors.lastname: Lu
authors.affiliation: Department of Gastric Surgery, Fujian Medical University Union Hospital, Fuzhou, China. hcmlr2002@163.com.
authors.forename: Chang-ming
authors.initials: CM
authors.lastname: Huang
authors.affiliation: Department of Gastric Surgery, Fujian Medical University Union Hospital, Fuzhou, China.
authors.forename: Chao-hui
authors.initials: CH
authors.lastname: Zheng
authors.affiliation: Department of Gastric Surgery, Fujian Medical University Union Hospital, Fuzhou, China.
authors.forename: Ping
authors.initials: P
authors.lastname: Li
authors.affiliation: Department of Gastric Surgery, Fujian Medical University Union Hospital, Fuzhou, China.
authors.forename: Jian-wei
authors.initials: JW
authors.lastname: Xie
authors.affiliation: Department of Gastric Surgery, Fujian Medical University Union Hospital, Fuzhou, China.
authors.forename: Jia-bin
authors.initials: JB
authors.lastname: Wang
authors.affiliation: Department of Gastric Surgery, Fujian Medical University Union Hospital, Fuzhou, China.
authors.forename: Jian-xian
authors.initials: JX
authors.lastname: Lin
authors.affiliation: Department of Gastric Surgery, Fujian Medical University Union Hospital, Fuzhou, China.
authors.forename: Qi-yue
authors.initials: QY
authors.lastname: Chen
authors.affiliation: Department of Gastric Surgery, Fujian Medical University Union Hospital, Fuzhou, China.
authors.forename: Long-long
authors.initials: LL
authors.lastname: Cao
authors.affiliation: Department of Gastric Surgery, Fujian Medical University Union Hospital, Fuzhou, China.
authors.forename: Mi
authors.initials: M
authors.lastname: Lin
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D005743:Gastrectomy / Q000379:methods*; D061847:Hospitals, High-Volume; D006801:Humans; D010535:Laparoscopy / Q000379:methods*; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000453:epidemiology / Q000209:etiology*; D057234:Preoperative Period; D012189:Retrospective Studies; D012307:Risk Factors; D013154:Spleen / Q000601:surgery*; D013274:Stomach Neoplasms / Q000601:surgery*; D016896:Treatment Outcome
keywords: Gastric cancer; Laparoscopic spleen-preserving total gastrectomy; Major complications; Scoring system