title: Risk factors affecting unplanned reoperation after laparoscopic gastrectomy for gastric cancer: experience from a high-volume center.
abstract: To evaluate the risk factors affecting unplanned reoperation (URO) after laparoscopic gastrectomy (LAG) for gastric cancer (GC) and establish a model to predict URO preoperatively.
  
  
  
  Between May 2007 and December 2014, we prospectively collected and retrospectively analyzed the data of 2608 GC patients who underwent LAG. Among them, 2580 patients not requiring an URO were defined as the Non-URO group, and 28 patients requiring an URO were defined as the URO group. Univariate, multivariate, and bootstrap analyses were performed to determine the independent predictors for URO, and a nomogram was constructed to preoperatively predict the rate of URO after LAG.
  
  
  
  Of the 2608 patients, the URO rate was 1.1% (28/2608) within the 30-day hospitalization. The mean URO time interval to first operation was 5.6 ± 5.5 (0.10-18.5) days. The main causes requiring URO were intraabdominal bleeding (57.1%), anastomotic bleeding (17.9%), anastomotic leakage (7.1%), and intraabdominal infection (7.1%). Compared to the Non-URO group, the URO group had a significantly longer hospital stay (p < 0.001) and significantly higher hospital fees (p < 0.001). The morbidity rate was 39.2% in the URO group and 14.5% in the non-URO group (p = 0.001), and mortality was 3.6% in the URO group and 0.2% in the non-URO group (p = 0.063). Multivariate analysis using bootstrap method revealed that age >70 years (odds ratio (OR) = 2.232, 95% confidence interval (CI) = 1.023-4.491, p = 0.028), male gender (OR = 32.983, 95% CI 1.405-25.343 × 106, p = 0.027), and body mass index (BMI) > 25 kg/m2(OR = 2.550, 95% CI 1.017-5.398, p = 0.012) were independent risk factors for URO. A multivariable nomogram model for predicting URO exhibited a strong optimism-adjusted discrimination (concordance index, 0.687). No significant correlation was noted between the URO rate and operative period by Spearman analysis (r = 0.012, p = 0.548).
  
  
  
  Age > 70 years, Male, and BMI > 25 kg/m2were independent risk factors for URO. Based on the three risk factors, we developed a simple and practical nomogram to predict URO preoperatively, which might aid surgeons in reducing the URO rate when planning to perform LAG for GC.
authors.affiliation: Department of Gastric Surgery, Fujian Medical University Union Hospital, No.29 Xinquan Road, Fuzhou, 350001, Fujian Province, China.
authors.forename: Ping
authors.initials: P
authors.lastname: Li
authors.affiliation: Department of Gastric Surgery, Fujian Medical University Union Hospital, No.29 Xinquan Road, Fuzhou, 350001, Fujian Province, 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, No.29 Xinquan Road, Fuzhou, 350001, Fujian Province, China.
authors.forename: Ru-Hong
authors.initials: RH
authors.lastname: Tu
authors.affiliation: Department of Gastric Surgery, Fujian Medical University Union Hospital, No.29 Xinquan Road, Fuzhou, 350001, Fujian Province, China.
authors.forename: Jian-Xian
authors.initials: JX
authors.lastname: Lin
authors.affiliation: Department of Gastric Surgery, Fujian Medical University Union Hospital, No.29 Xinquan Road, Fuzhou, 350001, Fujian Province, China.
authors.forename: Jun
authors.initials: J
authors.lastname: Lu
authors.affiliation: Department of Gastric Surgery, Fujian Medical University Union Hospital, No.29 Xinquan Road, Fuzhou, 350001, Fujian Province, China.
authors.forename: Chao-Hui
authors.initials: CH
authors.lastname: Zheng
authors.affiliation: Department of Gastric Surgery, Fujian Medical University Union Hospital, No.29 Xinquan Road, Fuzhou, 350001, Fujian Province, China.
authors.forename: Jian-Wei
authors.initials: JW
authors.lastname: Xie
authors.affiliation: Department of Gastric Surgery, Fujian Medical University Union Hospital, No.29 Xinquan Road, Fuzhou, 350001, Fujian Province, China.
authors.forename: Jia-Bin
authors.initials: JB
authors.lastname: Wang
authors.affiliation: Department of Gastric Surgery, Fujian Medical University Union Hospital, No.29 Xinquan Road, Fuzhou, 350001, Fujian Province, China.
authors.forename: Qi-Yue
authors.initials: QY
authors.lastname: Chen
authors.affiliation: Department of Gastric Surgery, Fujian Medical University Union Hospital, No.29 Xinquan Road, Fuzhou, 350001, Fujian Province, China.
authors.forename: Long-Long
authors.initials: LL
authors.lastname: Cao
authors.affiliation: Department of Gastric Surgery, Fujian Medical University Union Hospital, No.29 Xinquan Road, Fuzhou, 350001, Fujian Province, China.
authors.forename: Mi
authors.initials: M
authors.lastname: Lin
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002648:Child; D005260:Female; D005743:Gastrectomy / Q000009:adverse effects* / Q000379:methods; D006801:Humans; D010535:Laparoscopy / Q000009:adverse effects* / Q000379:methods; D007902:Length of Stay / Q000706:statistics & numerical data; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000453:epidemiology* / Q000209:etiology; D012086:Reoperation / Q000706:statistics & numerical data*; D012189:Retrospective Studies; D012307:Risk Factors; D024162:Second-Look Surgery; D013274:Stomach Neoplasms / Q000401:mortality / Q000601:surgery*; D055815:Young Adult
keywords: Gastrectomy; Laparoscopy surgical procedures; Postoperative complications; Reoperation; Stomach neoplasms