title: Impact of Abdominal Shape on Short-Term Surgical Outcome of Laparoscopy-Assisted Distal Gastrectomy for Gastric Cancer.
abstract: Laparoscopy-assisted distal gastrectomy (LADG) has been widely accepted for the treatment for gastric cancer. The aim of the present study was to explore the impact of abdominal shape parameters on gastric antrum cancer patients' short-term surgical outcomes of LADG with D2 lymph node dissection in both genders, including the number of lymph nodes retrieved and surgical safety index.
  
  
  
  This was a retrospective analysis of 177 gastric antrum cancer patients, who underwent LADG between April 2009 and January 2016. The abdominal shape parameters, including abdominal anterior-posterior diameter (APD), transverse diameter (TD), xiphoid process of the sternum-navel distance (XND), and thickness of subcutaneous fat (SCF) at the umbilicus level, were calculated by preoperative abdominal computed tomography (CT) scans. The effects of abdominal shape parameters on the short-term surgical outcomes of LADG were analyzed.
  
  
  
  In male patients undergoing LADG and D2 lymph node dissection, the number of retrieved lymph nodes was significantly lower in patients with APD ≥17.3 cm (P = 0.005), TD ≥27.4 cm (P = 0.029), SCF ≥1.2 cm (P = 0.014), and BMI ≥22.2 (P = 0.008), whereas in female patients, these were statistically insignificant (P > 0.05). APD, TD, SCF, and BMI were negatively correlated with the number of retrieved lymph nodes in male patients. There was no significant difference in the number of lymph nodes retrieved between high-XND group and low-XND group in either gender. Operation time was significantly shorter in male patients with XND < 17.0 cm (P = 0.044) and in female patients with SCF < 2.15 cm (P = 0.013). Intraoperative blood loss and postoperative complication rate were not significantly different between high- and low-APD groups, high- and low-TD groups, high- and low-XND groups, and high- and low-SCF groups in either gender. Compared with male patients, SCF and TD were significantly higher in female patients. In addition, a higher incidence rate of hypertension was observed in patients of both genders with large APD and SCF, although statistically significant only in male patients.
  
  
  
  LADG with D2 lymph node dissection can effectively achieve the lymph node dissection requirement of radical distal gastrectomy for patients with various abdominal shapes. It is worth noting that APD, TD, and SCF can impact on lymph node dissection of LADG in male patients. Nevertheless, in female patients, abdominal shape do not impact on lymph node dissection of LADG. Moreover, LADG with D2 lymph node dissection is proved to be safe for various abdominal shape in both genders, even for abdominal obese patients.
authors.affiliation: Department of Gastrointestinal Surgery, Shaoxing People's Hospital, Shaoxing Hospital of Zhejiang University, No. 568, Zhongxing North Road, Shaoxing, 312000, Zhejiang Province, China. wwsjd@163.com.
authors.forename: Wei
authors.identifier: 0000-0003-3185-2487
authors.initials: W
authors.lastname: Wang
authors.affiliation: Department of General Surgery, Tongji Hospital, Tongji University School of Medicine, Shanghai, 200065, China.
authors.forename: Kai-Xing
authors.initials: KX
authors.lastname: Ai
authors.affiliation: Department of Gastrointestinal Surgery, Shaoxing People's Hospital, Shaoxing Hospital of Zhejiang University, No. 568, Zhongxing North Road, Shaoxing, 312000, Zhejiang Province, China.
authors.forename: Feng
authors.initials: F
authors.lastname: Tao
authors.affiliation: Department of Gastrointestinal Surgery, Shaoxing People's Hospital, Shaoxing Hospital of Zhejiang University, No. 568, Zhongxing North Road, Shaoxing, 312000, Zhejiang Province, China.
authors.forename: Ke-Tao
authors.initials: KT
authors.lastname: Jin
authors.affiliation: Department of Gastrointestinal Surgery, Shaoxing People's Hospital, Shaoxing Hospital of Zhejiang University, No. 568, Zhongxing North Road, Shaoxing, 312000, Zhejiang Province, China.
authors.forename: Yuan-Ming
authors.initials: YM
authors.lastname: Jing
authors.affiliation: Department of Gastrointestinal Surgery, Shaoxing People's Hospital, Shaoxing Hospital of Zhejiang University, No. 568, Zhongxing North Road, Shaoxing, 312000, Zhejiang Province, China.
authors.forename: Guan-Gen
authors.initials: GG
authors.lastname: Xu
authors.affiliation: Department of Gastrointestinal Surgery, Shaoxing People's Hospital, Shaoxing Hospital of Zhejiang University, No. 568, Zhongxing North Road, Shaoxing, 312000, Zhejiang Province, China.
authors.forename: Jie-Qing
authors.initials: JQ
authors.lastname: Lv
authors.affiliation: Department of Radiology, Shaoxing People's Hospital, Shaoxing Hospital of Zhejiang University, Shaoxing, 312000, Zhejiang Province, China.
authors.forename: Ting
authors.initials: T
authors.lastname: Wang
authors.affiliation: Department of Pathology, Shaoxing People's Hospital, Shaoxing Hospital of Zhejiang University, Shaoxing, 312000, Zhejiang Province, China.
authors.forename: Jian-Guo
authors.initials: JG
authors.lastname: Wei
authors.affiliation: Department of Pathology, School of Medicine, Shaoxing University, Shaoxing, 312000, Zhejiang Province, China.
authors.forename: Ai-Jing
authors.initials: AJ
authors.lastname: Sun
authors.affiliation: Department of Statistics, School of Medicine, Shaoxing University, Shaoxing, 312000, Zhejiang Province, China.
authors.forename: Hai-Yan
authors.initials: HY
authors.lastname: Xing
mesh_terms: D000005:Abdomen / Q000033:anatomy & histology* / Q000000981:diagnostic imaging; D000368:Aged; D059925:Anatomic Landmarks; D016063:Blood Loss, Surgical; D015992:Body Mass Index; D005260:Female; D005743:Gastrectomy / Q000009:adverse effects / Q000379:methods*; D006801:Humans; D006973:Hypertension / Q000150:complications; D010535:Laparoscopy / Q000379:methods; D008197:Lymph Node Excision; D008198:Lymph Nodes / Q000473:pathology / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D061646:Operative Time; D011183:Postoperative Complications / Q000601:surgery; D011706:Pyloric Antrum / Q000601:surgery; D012189:Retrospective Studies; D012737:Sex Factors; D013274:Stomach Neoplasms / Q000150:complications / Q000601:surgery*; D050151:Subcutaneous Fat / Q000033:anatomy & histology / Q000000981:diagnostic imaging; D014057:Tomography, X-Ray Computed; D014472:Umbilicus
keywords: Abdominal shape; Gastric cancer; Laparoscopy-assisted distal gastrectomy; Short-term surgical outcome