A Simple Predictive Index of the Abdominal Shape for Postoperative Complications After Laparoscopy-Assisted Distal Gastrectomy for Gastric Cancer

Background: The purpose of this study was to explore the effect of abdominal shape on the short-term surgical outcomes.Methods: This was a retrospective study that included 425 patients undergoing laparoscopic distal gastrectomy plus D2 lymph node dissection (LADG) from January 2013 to January 2021. The abdominal parameters, including the shortest distance of the pancreas from the anterior abdominal skin (PAAD), the lower sternum angle (LSA), the thickness of the subcutaneous fat at the navel level (SFT), the anteroposterior diameters (APD) and the left-right diameters (LRD) at the navel level, the distance from the xiphoid process to the navel (XND) and the distance from the xiphoid process to the pubis (XBD), were calculated by preoperative abdominal computed tomography (CT) imaging. The parameters and short-term surgical outcomes were analyzed.Results: In males, the number of retrieved lymph nodes was significantly higher in patients with a lower APD group (p = 0.031). The operation time was significantly shorter in the lower body mass index (BMI) (p = 0.007), lower LSA (p = 0.035), lower PAAD (p = 0.000), lower SFT (p = 0.004), lower APD (p = 0.000) and lower LRD (p = 0.014) groups. The estimated blood loss was significantly less in the lower BMI (p = 0.035), lower LSA (p = 0.001), lower PAAD (p = 0.012), lower SFT (p = 0.003), lower APD (p = 0.000) and lower LRD (p = 0.005) groups. The complications were fewer in the lower LSA (p = 0.012), lower APD (p = 0.043) and lower LRD (p = 0.023) groups. In females, the postoperative hospital stay was shorter in the lower PAAD (p = 0.027) and lower SFT (p = 0.004) groups, and the lower SFT group had fewer complications (p = 0.020). Furthermore, in multivariate analysis, higher PAAD (p = 0.037, odds ratio = 1.030, 95% CI = 1.002–1.059) was an independent factor for predicting postoperative complications in males.Conclusion: Various abdominal shapes can affect the difficulty of LADG. Higher PAAD is a simple independent index for predicting postoperative complications in males.

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A Simple Predictive Index of the Abdominal Shape for Postoperative Complications After Laparoscopy-Assisted Distal Gastrectomy for Gastric Cancer

10.21203/rs.3.rs-523946/v1 ◽

2021 ◽

Author(s):

Wei Tao ◽

Yuxi Cheng ◽

Xiao-Yu Liu ◽

Bin Zhang ◽

Chao Yuan ◽

...

Keyword(s):

Postoperative Complications ◽

Surgical Outcomes ◽

Distal Gastrectomy ◽

Subcutaneous Fat ◽

Operation Time ◽

Short Term ◽

Predictive Index ◽

Xiphoid Process ◽

Estimated Blood Loss ◽

Abdominal Shape

Abstract Purpose The purpose of this study was to explore the effect of abdominal shape on the short-term surgical outcomes of laparoscopic distal gastrectomy + D2 lymph node dissection (LADG). Methods This was a retrospective study that included 425 patients undergoing LADG from January 2013 to January 2021 at a single clinical center. The abdominal parameters, including the shortest distance of the pancreas from the anterior abdominal skin (PAAD), the lower sternum angle (LSA), the thickness of the subcutaneous fat at the navel level (SFT), the anteroposterior diameters (APD) and the left-right diameters (LRD) at the navel level, the distance from the xiphoid process to the navel (XND) and the distance from the xiphoid process to the pubis (XBD), were calculated by preoperative abdominal computed tomography (CT) imaging. The abdominal parameters and short-term surgical outcomes were analyzed. Results In males, the number of retrieved lymph nodes was significantly higher in patients with a lower APD group (p=0.031). The operation time was significantly shorter in the lower body mass index (BMI) (p=0.007), lower LSA (p=0.035), lower PAAD (p=0.000), lower SFT (p=0.004), lower APD (p=0.000) and lower LRD (p=0.014) groups. The estimated blood loss was significantly less in the lower BMI (p=0.035), lower LSA (p=0.001), lower PAAD (p=0.012), lower SFT (p=0.003), lower APD (p=0.000) and lower LRD (p=0.005) groups. The complications were fewer in the lower LSA (p=0.012), lower APD (p=0.043) and lower LRD (p=0.023) groups. In females, the postoperative hospital stay was shorter in the lower PAAD (p=0.027) and lower SFT (p=0.004) groups, and the lower SFT group had fewer complications (p=0.020). Furthermore, in multivariate analysis, higher PAAD (p=0.029, odds ratio=1.030, 95% CI=1.003-1.058) was an independent factor for predicting postoperative complications in males. Conclusion Various abdominal shapes can affect the difficulty of LADG. Higher PAAD is a simple independent index for predicting postoperative complications in males.

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The Shortest Distance from the Skin to Pancreas and the Lower Sternum Angle can Influence Short-Term Surgical Outcomes of Laparoscopy-Assisted Distal Gastrectomy for Gastric Cancer

10.21203/rs.3.rs-84004/v1 ◽

2020 ◽

Author(s):

Dong Peng ◽

Wei Tao ◽

Yuxi Cheng ◽

Ying-Ying Zou ◽

Kun Qian ◽

...

Keyword(s):

Gastric Cancer ◽

Surgical Outcomes ◽

Distal Gastrectomy ◽

Subcutaneous Fat ◽

Short Term ◽

Xiphoid Process ◽

Female Patients ◽

Shortest Distance ◽

Estimated Blood Loss ◽

Male Patients

Abstract Background The surgery of laparoscopic distal gastrectomy + D2 lymph node dissection (LADG) is widely used in patients with gastric cancer, the purpose of the study is to explore the effect of abdominal shape on short-term surgical outcomes.Methods This was a retrospective study which included 316 patients undergoing LADG from January 2013 to June 2019 at a single clinical center. The abdominal parameters including the shortest distance of the pancreas from the anterior abdominal skin (PAAD), the lower sternum angle (LSA), the thickness of subcutaneous fat at the navel level (SFT), the anteroposterior diameters (APD) and left-right diameters(LRD) at the navel level, the distance from xiphoid process to the navel (XND), and the distance from xiphoid process to the pubis (XBD) were calculated by preoperative abdominal computed tomography (CT) image. The parameters and short-term surgical outcomes were analyzed.Results In males, the number of retrieved lymph nodes was significantly higher in patients with BMI <25kg/m2 (p=0.023) and APD <176.2mm (p=0.004). The time of operation was significantly shorter in male patients with BMI <25kg/m2(p=0.001), PAAD <64.6mm(p=0.000), SFT <14.9mm(p=0.017), APD <176.2mm(p=0.002) and LRD <290.0mm(p=0.036), and in female patients with XBD >370.0mm(p=0.042). The estimated blood loss was significantly lower in male patients with LSA <83.8° (p=0.009), PAAD <64.6mm(p=0.001), SFT <14.9mm(p=0.001), APD <176.2mm(p=0.009) and LRD <290.0mm(p=0.011). The complications were fewer in male patients with PAAD <64.6mm(p=0.045) and APD <176.2mm(p=0.011), and in female patients with LRD <288.5mm(p=0.047).Conclusion Various abdominal shapes can influence the difficulty of LADG. Lower LSA and PAAD can reduce the difficulty of LADG in male patients.

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Impact of an Ultrasonically Activated Device in Robot-Assisted Distal Gastrectomy

Innovations Technology and Techniques in Cardiothoracic and Vascular Surgery ◽

10.1097/imi.0000000000000437 ◽

2017 ◽

Vol 12 (6) ◽

pp. 453-458

Author(s):

Makoto Hikage ◽

Masanori Tokunaga ◽

Rie Makuuchi ◽

Yutaka Tanizawa ◽

Etsuro Bando ◽

...

Keyword(s):

Gastric Cancer ◽

Blood Loss ◽

Surgical Outcomes ◽

Distal Gastrectomy ◽

Operation Time ◽

Patient Characteristics ◽

Clinicopathological Characteristics ◽

Robot Assisted ◽

Estimated Blood Loss ◽

Device Use

Objective Robot-assisted gastrectomy is increasingly used for the treatment of gastric cancer, although it remains a time-consuming procedure. An ultrasonically activated device might be useful to shorten operation times. This study therefore assessed the effect of ultrasonically activated device use on procedural times and on other early surgical outcomes. Methods Consecutive patients (N = 42) who underwent robot-assisted distal gastrectomy for gastric cancer were included. Clinicopathological characteristics and early surgical outcomes were compared between robotic-assisted gastrectomy procedures using an ultrasonically activated device (U group, n = 21) and those without it (NU group, n = 21). Results There were no significant differences in patient characteristics between the groups; however, the median operation time was significantly less in the U group than in the NU group (291 vs 351 minutes, P = 0.006). In detail, the median duration of console time until dividing the duodenum was less in the U group (70 vs 102 minutes, P < 0.001). Estimated blood loss, incidence of postoperative morbidity, and duration of postoperative hospital stay were not different between the groups. Conclusions An ultrasonically activated device reduced the operation time of robot-assisted gastrectomy without increasing blood loss and morbidity.

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Short-term and long-term outcomes of robotic, laparoscopic and open radical gastrectomy in gastric cancer: A single-center retrospective study

10.21203/rs.2.15339/v1 ◽

2019 ◽

Author(s):

Weifan Zhang ◽

Xinhui Zhao ◽

Zhao Liu ◽

Hui Dang ◽

Lei Meng ◽

...

Keyword(s):

Gastric Cancer ◽

Lymph Nodes ◽

Learning Curve ◽

Operation Time ◽

Open Gastrectomy ◽

Short Term ◽

Term Outcome ◽

Long Term Outcome ◽

Estimated Blood Loss

Abstract Background: Few studies on the comparison among robotic, laparoscopic, and open gastrectomy had been reported in gastric cancer . The goal of this study was to evaluate the advantages of robotic-assisted gastrectomy (RAG) by comparing with laparoscopic-assisted gastrectomy(LAG) and open gastrectomy (OG). Methods: 147 gastric cancer patients who underwent gastrectomy were enrolled and retrospectively analyzed between January 2017 and July 2019. Short-term outcomes such as operation time, intraoperative estimated blood loss(EBL),number of retrieved lymph nodes, postoperative recovery, learning curve, and long-term outcome such as overall survival(OS) was compared among RAG, LAG and OG groups. Results: RAG group included 47 patients, 44 in the LAG, and 61 in the OG. Basic information such as gender, age, BMI, ASA degree were similar among three groups, and there were no statistically significances in pathological TNM staging, tumor resection extent, resection margin, methods of reconstruction( P ＞0.05). The cumulative sum(CUSUM) method showed that learning curve of RAG reached stability after 17 cases . For short-term outcomes, the RAG group had the shortest EBL( P =0.033), the shortest time to first flatus( P ＜0.001), shortest time to first intake liquid diet ( P =0.004),shortest postoperative hospital stay ( P =0.023)and the largest number of retrieved lymph nodes( P =0.044),the longest operation time( P ＜0.001), the most expensive treatment cost( P ＜0.001),however, there were no significant differences in postoperative drainage, postoperative white blood cell(WBC)count and early complications among three group( P ＞0.05). In addition to long-term outcome, similar OS was observed in three groups. Conclusion: Compared with LAG and OG, RAG has certain advantages in short-term outcomes and is a safe and reliable surgical method. But still need further prospective, multi-center research to confirm this.

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Laparoscopic Risk-Reducing Salpingo-Oophorectomy: The Brigham and Women's Experience

ISRN Minimally Invasive Surgery ◽

10.5402/2012/763290 ◽

2012 ◽

Vol 2012 ◽

pp. 1-7 ◽

Cited By ~ 2

Author(s):

Melina Shoni ◽

Taymaa May ◽

Allison F. Vitonis ◽

Anjelica Garza ◽

Michael G. Muto ◽

...

Keyword(s):

Surgical Outcomes ◽

Operative Time ◽

Intraoperative Complications ◽

Admission Rate ◽

Safe Procedure ◽

Short Term ◽

Surgical Morbidity ◽

Hospital Admission Rate ◽

Estimated Blood Loss ◽

Risk Reducing

Objective. To establish short-term surgical outcomes of three-port laparoscopic risk-reducing salpingo-oophorectomy (RRSO) in women with hereditary breast-ovarian cancer syndrome (HBOC). Methods. The medical records of all HBOC women that underwent laparoscopic RRSO between January 2001 and December 2010 were retrospectively reviewed. Demographic data, operative details, and short-term surgical outcomes were obtained and subjected to SAS. Statistical univariate and multivariate analyses were performed. Results. 358 patients met study criteria with 277 (77.4%) carrying a documented BRCA mutation. The predominant technique utilized three ports (two 5 mm and one 10/12 mm), a 5 mm laparoscope and a 5 mm Ligasure pulsatile bipolar device. Mean operative time was 58.3 minutes (SD 22.6, 26.0–197.0), significantly affected by BMI greater than 30 (P<0.0001) and status of adhesions (P=0.001). Estimated blood loss (EBL) was negligible in 96.9% of cases. Seven patients required conversion to laparotomy. No major intraoperative complications were recorded. One-night hospital admission rate was less than 2.0% while postoperative complication rate was 3.1%. Malignancy was revealed in 14 patients (3.9%). Conclusion. In HBOC population, three-port laparoscopic RRSO is a simple, reproducible, and safe procedure with low conversion rate, short operative time, minimal EBL, low surgical morbidity, and rapid postoperative recovery.

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Morbidity Associated with Diverting Loop Ileostomies: Weighing Diversion in Rectosigmoid Resection

The American Surgeon ◽

10.1177/000313481708300739 ◽

2017 ◽

Vol 83 (7) ◽

pp. 786-792

Author(s):

Nathan Belkin ◽

Liliana G. Bordeianou ◽

Paul C. Shellito ◽

Alexander T. Hawkins

Keyword(s):

Adjuvant Chemotherapy ◽

Postoperative Complications ◽

Anterior Resection ◽

Massachusetts General Hospital ◽

Perioperative Complications ◽

Primary Anastomosis ◽

Operation Time ◽

Emergency Department Visits ◽

Rectosigmoid Resection ◽

Estimated Blood Loss

Anterior resection with primary anastomosis is the procedure of choice for patients with rectosigmoid cancers with good sphincter function. Surgeons may perform an associated diverting loop ileostomy (DLI) to minimize the likelihood and/or the severity of an anastomotic leak. To examine the morbidity of DLIs, we performed a review of a prospectively maintained database. Participants included all patients at the Massachusetts General Hospital who underwent anterior resection from January 2013 to July 2015 for rectosigmoid cancers and who subsequently underwent adjuvant chemotherapy. The primary outcome was time to start of adjuvant chemotherapy. Secondary outcomes included length of hospitalization, perioperative complications, and 60-day postoperative complications. Inclusion criteria were met in 57 patients and DLI was performed in 21 (37%). The DLI group had higher estimated blood loss (431.7 vs 192.1 mL, P = 0.03) and a longer operation time (3.7 vs 2.3 hours, P = 0.0007). The DLI group took over a week longer to start adjuvant chemotherapy than the non-DLI group (median time to chemo: 43 vs 34 days, P = 0.002). Postoperatively, DLI was associated with a longer hospitalization (6.7 vs 3.1 days, P = 0.0003), more perioperative complications (57.1% vs 13.9%, P = 0.0006), and more 60-day read-missions or emergency department visits (38.1% vs 5.6%, P = 0.002). Ostomies are associated with appreciable morbidity. In turn, they do not eliminate postoperative complications. Surgeons should closely consider ostomy morbidity in rectosigmoid resection and institute a proactive approach toward identification and prevention of complications.

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Impact of Age and Comorbidity on the Short-Term Surgical Outcome after Laparoscopy-Assisted Distal Gastrectomy for Adenocarcinoma

The American Surgeon ◽

10.1177/000313481307900123 ◽

2013 ◽

Vol 79 (1) ◽

pp. 40-48 ◽

Cited By ~ 9

Author(s):

Han-A Park ◽

Seong-Heum Park ◽

Sung-Il Cho ◽

You-Jin Jang ◽

Jong-Han Kim ◽

...

Keyword(s):

Risk Factors ◽

Elderly Patients ◽

Surgical Outcomes ◽

Surgical Outcome ◽

Distal Gastrectomy ◽

Outcome Data ◽

University Hospitals ◽

Short Term ◽

Aged Patients ◽

Systemic Complications

The aim of this study was to determine whether age and comorbidity are valuable risk factors of the short-term surgical outcome after laparoscopy-assisted distal gastrectomy (LADG) in patients with adenocarcinoma. A series of 387 patients who underwent LADG at three university hospitals between March 2006 and December 2010 were retrospectively studied. To compare the short-term surgical outcomes of LADG of elderly patients with those of younger patients, patients were categorized into an elderly group (older than 70 years of age) and a younger group (70 years of age or younger). For another comparative analysis to identify risk factors of postoperative complications after LADG, patients were categorized into two groups: those with complications and those without complications. With the exception of sex ratio and comorbidity rate, two age groups were nonsignificantly different in terms of demographic, operative, pathologic, and short-term surgical outcome data. Our data support the safety and feasibility of LADG in elderly patients. However, our data show that comorbidity is an important predictor of postoperative systemic complications after LADG. Patients with an age-adjusted Charlson comorbidity index (CCI) of 3 or greater were found to be at a greater risk of developing systemic complications, which suggests that age-adjusted CCI is a useful predictor of systemic complications after LADG and that it could be used routinely for the perioperative care of aged patients with comorbidity. We recommend age-adjusted CCI be used in comparative clinical research studies on the surgical outcomes across surgeons and hospitals.

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The Impact of Comorbid Diabetes on Short-Term Postoperative Outcomes in Stage I/II Colon Cancer Patients Undergoing Open Colectomy

BioMed Research International ◽

10.1155/2020/2716395 ◽

2020 ◽

Vol 2020 ◽

pp. 1-11

Author(s):

Ko-Chao Lee ◽

Kuan-Chih Chung ◽

Hong-Hwa Chen ◽

Kung-Chuan Cheng ◽

Kuen-Lin Wu ◽

...

Keyword(s):

Colon Cancer ◽

Postoperative Complications ◽

Hospital Mortality ◽

Cancer Patients ◽

Surgical Outcomes ◽

Stage I ◽

Open Colectomy ◽

Short Term ◽

Patients With Diabetes ◽

The Impact

Purpose. This study aimed at evaluating the impact of comorbid diabetes on short-term postoperative outcomes in patients with stage I/II colon cancer after open colectomy. Methods. The data were extracted from the National Inpatient Sample database (2005-2010). Short-term surgical outcomes included in-hospital mortality, postoperative complications, and hospital length of stay. Results. A total of 49,064 stage I/II colon cancer patients undergoing open surgery were included, with a mean age of 70.35 years. Of them, 21.94% had comorbid diabetes. Multivariable analyses revealed that comorbid diabetes was significantly associated with a lower risk of in-hospital mortality and postoperative complications. Compared to patients without diabetes, patients with uncomplicated diabetes had lower percentages of in-hospital mortality and postoperative complications, but patients with complicated diabetes had a higher percentage of postoperative complications. In addition, patients with diabetes only, but not patients with diabetes and hypertension only, had a lower percentage of in-hospital mortality than patients without any comorbidity. Conclusion. The present results suggested the protective effects of uncomplicated diabetes on short-term surgical outcomes in stage I/II colon cancer patients after open colectomy. Further studies are warranted to confirm these unexpected findings and investigate the possible underlying mechanisms.

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Surgical Outcomes of LigaSure Hemorrhoidectomy in the Elderly Population: A retrospective cohort study

BMC Gastroenterology ◽

10.1186/s12876-021-01969-1 ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

Chuang-Wei Chen ◽

Tzung-Ju Lu ◽

Koung-Hung Hsiao

Keyword(s):

Cohort Study ◽

Postoperative Complications ◽

Surgical Outcomes ◽

Multivariate Logistic Regression Analysis ◽

Operation Time ◽

Admission Rate ◽

Complication Rates ◽

Time Duration ◽

Significant Difference ◽

Prone Jackknife Position

Abstract Background This study aims to assess the association between age and outcomes in patients undergoing hemorrhoidectomy. Methods This is a population-based cohort study. A retrospectively collected database with consecutive patients whose symptomatic prolapsed hemorrhoids managed by the LigaSure hemorrhoidectomy between Jan. 2015 and May 2017 was reviewed. Among 1238 patients, 1075 were under 65 years old (group 1), and 163 were 65 years old or older (group 2). Both groups were compared regarding baseline characteristics and surgical outcomes. Results All patients tolerated the whole course of the operation in the prone jackknife position without anesthetic-associated complications. There was no significant difference between these two groups regarding sex, hemorrhoids grade, operation time, duration of hospital stays, postoperative pain score, analgesic consumption, total postoperative complications, re-admission rate, reoperation rate and follow-up times. The multivariate logistic regression analysis that may contribute to postoperative complications revealed no significant difference for all complications between both groups. Conclusion The LigaSure hemorrhoidectomy for elderly patients is safe and effective without significant difference in short-term operative outcomes and all complication rates, compared with younger patients.

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Effect of endoscopic resection on short-term surgical outcomes of subsequent laparoscopic gastrectomy: a meta-analysis

World Journal of Surgical Oncology ◽

10.1186/s12957-021-02230-5 ◽

2021 ◽

Vol 19 (1) ◽

Author(s):

Dong Peng ◽

Yu-Xi Cheng ◽

Gang Liao

Keyword(s):

Endoscopic Resection ◽

Laparoscopic Gastrectomy ◽

Surgical Outcomes ◽

Meta Analysis ◽

Operation Time ◽

Oral Feeding ◽

Cochrane Library ◽

Short Term ◽

Significant Difference ◽

Grade Ii

Abstract Background Endoscopic resection (ER) might affect subsequent laparoscopic gastrectomy (LG) because of the electrical coagulation, but the effect remains controversial. The purpose of this meta-analysis was to analyze the effect of ER on the short-term surgical outcomes of subsequent LG. Materials and methods The PubMed, EMBASE, and Cochrane Library databases were searched to find eligible studies published from inception to March 21, 2021. Short-term surgical outcomes were compared between the ER-LG group and the LG-only group. The registration ID of this current meta-analysis on PROSPERO is CRD42021238031. Results Nine studies involving 3611 patients were included in this meta-analysis. The LG-only group had a higher T stage (T1-T2: OR=2.42, 95% CI=1.09 to 5.34, P=0.03; T3-T4: OR=0.41, 95% CI=0.19 to 0.91, P=0.03) than the ER-LG group. The ER-LG group showed a shorter operation time than the LG-only group (MD=−5.98, 95% CI=−10.99 to −0.97, P=0.02). However, no difference was found in operation time after subgroup analysis of propensity score matching studies. No significant difference was found in intraoperative blood loss, time to first oral feeding, or postoperative hospital stay between the ER-LG group and the LG-only group. And no significance was found in overall complications (OR=1.16, 95% CI=0.89 to 1.50, P=0.27), complications of grade ≥ II (OR=1.11, 95% CI=0.71 to 1.73, P=0.64), complications of grade ≥ III b (OR=1.47, 95% CI=0.49 to 4.43, P=0.49) between the ER-LG group and the LG-only group. Conclusions ER did not affect subsequent LG in terms of short-term outcomes, and the ER-LG group might have a shorter operation time than the LG-only group.

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