Impact of preoperative comorbidities on abdominal complications after laparoscope-assisted total gastrectomy for gastric cancer

Objective To investigate the impact of preoperative comorbidities on the abdominal complications after laparoscope-assisted total gastrectomy (LATG) for gastric cancer. Methods The retrospective case-control study was conducted. The clinical data of 1 657 gastric cancer patients who underwent LATG at the Fujian Medical University Union Hospital between January 2008 and December 2015 were collected. There were 175 patients with postoperative abdominal complications, including 78 without preoperative comorbidities and 97 with preoperative comorbidities (52 with 1 comorbidity, 30 with 2 comorbidities and 15 with more than 3 comor-bidities). Analysis method and observation indicators: (1) risk factors analysis of abdominal complications after LATG; (2) risk assessment of abdominal complications after LATG: independent influencing factors of risk factors analysis were expressed as dependent variables, alignment diagram was built and then consistency index was calculated; (3) comparisons of abdominal complications among the patients with different kinds of comorbidities after LATG; (4) multivariate analysis of abdominal complications in patients with comorbidities after LATG; (5) follow-up situations. Follow-up using outpatient examination and telephone interview was performed to detect postoperative survival of patients up to May 2016. The univariate analysis and multivariate analysis were respectively done using the chi-square test and Logistic regression model. The survival rate was calculated by the Kaplan-Meier method. Results (1) Risk factors analysis of abdominal complications after LATG: results of univariate analysis showed that age, body mass index (BMI), number of preoperative comorbidities, operation time and estimated volume of intraoperative blood loss were related factors affecting abdominal complications of patients after LATG (χ2=4.487, 16.602, 10.361, 4.567, 7.482, P 82 mL were independent risk factors affecting abdominal complications of patients with preoperative comorbidities after LATG (OR=2.104, 1.771 , 95%CI: 1.307-3.387, 1.146-2.738, P<0.05). (5) Follow-up situations: of 1 657 patients, 1 568 were followed up for 4-99 months, with a median time of 47 months. Ninety-seven patients with preoperative comorbidities undergoing LATG had postoperative abdominal complications and were followed up. During follow-up, 5-year survival rate of patients was 58.1%, and 5-year survival rate of 97 patients with preoperative comorbidities undergoing LATG and with postoperative abdominal complications was 57.4%. Conclusion Preoperative comorbidities are independent factors affecting abdominal complications of patients after LATG. Key words: Gastric neoplasms; Gastrectomy; Comorbidities, preoperation; Complications, abdomen; Laparoscopy