Objective: To identify the risk factors of perioperative complications after radical gastrectomy for gastric cancer. Methods: A retrospective case-control study was performed. Case inclusion criteria: (1) patients undergoing radical gastrectomy (D2); (2) primary gastric cancer without distant organ metastasis confirmed by postoperative pathology; (3) no neoadjuvant chemotherapy before surgery. Patients with peritoneal tumor dissemination found during operation, undergoing palliative operation due to distant metastasis, and undergoing combined organ resection and those without complete clinicopathological data were excluded. According to the above criteria, 426 patients with gastric cancer at our department from January 2015 to June 2017 were included in this study. Of 426 patients, 285 were male and 141 were female with a mean age of (55.4±9.7) years. According to the "Japan Clinical Cancer Research Group (JCOG) classification criteria for postoperative complications of gastric cancer", patients with grade II and higher complications were classified as complication group, and patients with no complication or grade I complication were classified as non-complication group. Baseline data were compared between two groups. Associations of perioperative complication with gender, age, body mass index, preoperative routine laboratory test, American Society of Anesthesiologists (ASA) classification, activities of daily living (ADL) assessment, past medical history as well as preoperative conditions (hypertension and/or diabetes), surgical resection procedure, incision type, operation time, intraoperative blood loss/body mass ratio were examined. Univariate analysis was performed using χ(2) test and the Wilcoxon rank sum test to screen the statistically significant variables associated with perioperative complications. The significant variables were included in multivariate logistic regression analysis to identify risk factors of perioperative complication. Results: Grade II or higher complications after surgery were developed in 97 patients (22.8%), which included anastomotic leakage in 18 cases (4.2%), postoperative bleeding in 9 cases (2.1%), abdominal abscess in 5 cases (1.2%), intestinal obstruction in 5 cases (1.2%), pancreatic leakage in 1 case (0.2%), and other adverse events in 59 cases (13.8%). Univariate analysis suggested that the gender, age, ADL, incision type, intraoperative blood loss/body mass ratio, and operation time were associated with perioperative complication (all P<0.05). Multivariate analysis revealed that elder age (OR=1.033, 95% CI:1.013-1.053, P=0.013), incision type of laparotomy (OR=2.091, 95% CI:1.247-3.508, P=0.004), longer operation time (OR=1.004, 95% CI:1.001-1.007, P=0.001) and higher ratio of intraoperative blood loss/body mass (OR=1.100, 95% CI: 1.039-1.163, P=0.031) were risk factors for postoperative complications. Conclusion: Attention should be paid to those cases with elder age, laparotomy incision, longer operation time and higher ratio of intraoperative blood loss/body mass, and perioperative management after gastrectomy should be improved.
目的： 探究胃癌根治术后围手术期发生并发症的危险因素。 方法： 采用回顾性病例对照研究的方法。研究对象纳入标准：（1）行胃癌（D(2)）根治术患者；（2）术后经病理证实为原发性胃癌，且无远处脏器转移者；（3）术前未行新辅助化疗。排除术中见肿瘤腹腔播散或远处转移而转行姑息手术者、联合其他脏器切除手术者和临床资料或病理学资料不全者。2015年1月至2017年6月期间，广西医科大学第一附属医院胃肠腺体外科的426例患者符合上述标准入组。其中男285例，女141例；年龄（55.4±9.7）岁。按照"日本临床肿瘤研究组（JCOG）胃癌术后并发症分级标准"，将出现Ⅱ级及以上并发症定义为发生并发症，将未发生并发症及出现Ⅰ级并发症定义为未发生并发症。分析患者性别、年龄、体质指数、术前常规实验室检查指标、美国麻醉医师协会（ASA）分级、入院日常生活能力（ADL）评估、既往病史（包括是否患高血压病或糖尿病）等术前情况和手术切除方式、切口类型、手术时间、术中出血量/体质量比等与胃癌根治术围手术期发生并发症的关系。单因素分析采用χ(2)检验和Wilcoxon符号秩和检验，将单因素分析中差异有统计学意义的变量纳入多因素logistic回归分析。 结果： 本组有97例（22.8%）术后发生Ⅱ级以上并发症。并发症主要为吻合口漏18例（4.2%），术后出血9例（2.1%），腹腔脓肿5例（1.2%），肠梗阻5例（1.2%），胰漏1例（0.2%）以及其他不良事件59例（13.8%）。单因素分析结果显示，患者性别、年龄、入院ADL评估、切口类型、术中出血量/体质量比以及手术时间与胃癌围手术期并发症发生均有关（均P<0.05）。多因素分析结果显示，高龄（OR=1.033，95%CI：1.013~1.053，P=0.013）、切口类型为开腹（OR=2.091，95%CI：1.247~3.508，P=0.004）、手术时间较长（OR=1.004，95%CI：1.001~1.007，P=0.001）以及术中出血/体质量比高（OR=1.100，95%CI：1.039~1.163，P=0.031）是胃癌根治术后并发症发生的独立危险因素。 结论： 关注高龄、手术切口类型为开腹、手术时间长和术中出血/体质量比高的胃癌根治术患者，加强胃癌术后围手术期的管理。.
Keywords: Postoperative complications; Risk factors; Stomach neoplasms.