Xiao Hua, Pan Shu-guang, Yin Bin, Luo Wei, Quan Hu, Qiu Xiao-xin, Hong Yuan, Zuo Chao-hui
Department of Gastric, Duodenal & Pancreatic Surgery, Affiliated Tumor Hospital, Xiangya Medical School, Central South University, Changsha 410013, China.
Department of Gastric,Duodenal & Pancreatic Surgery, Affiliated Tumor Hospital, Xiangya Medical School, Central South University, Changsha 410013, China.
Zhonghua Yi Xue Za Zhi. 2013 Dec;93(46):3667-70.
To explore the complications after radical gastrectomy in patients with gastric cancer according to Clavien-Dindo classification and examine the major risk factors for complications.
From October 2010 to June 2013, a total of 614 patients undergoing radical gastrectomy at Department of Gastric,Duodenal & Pancreatic Surgery at Hunan Provincial Tumor Hospital were divided into 2 groups according to the occurrence of complications (n = 76, 12.38%) or not (n = 538, 87.62%). Their clinicopathological data, such as age, gender, co-morbidities, surgical duration, operative blood loss volume and pathological stage were retrospectively analyzed by Logistic regression with a case-control model.
Among them, 76 patients developed complications (12.38%). According to Clavien-Dindo classification, 56(9.12%), 14(2.28%), 3(0.49%) and 3(0.49%) patients suffered stage II, III, IV and V complications respectively. Comparing with the control group, the patients had a higher transfusion rate (43.42% (n = 33) vs 24.16% (n = 130), P < 0.01) and a longer postoperative hospital stay in the complication group ((23 ± 18) vs (14 ± 6) days, P < 0.01). There was no difference in age, gender, body mass index (BMI), number of dissected lymph node, levels of hemoglobin and albumin at admission, intraoperative hemorrhage, surgical duration and pathological TNM stage in two groups (all P > 0.05). Univariate analysis revealed that BMI > 25 kg/m(2), co-morbidities, diabetes mellitus, complications due to gastric cancer, hemoglobin <100 g/L, albumin <30 g/L, ascites, total gastrectomy, combined multi-organ resection, surgical duration >240 min and perioperative transfusion were associated with postoperative complications (all P < 0.05).Further multivariate analysis showed that perioperative transfusion (OR = 2.78, 95%CI: 1.42-5.43, P < 0.01) and combined multi-organ resection (OR = 1.72, 95%CI: 1.14-2.58, P = 0.01) were independent risk factors for postoperative complications after radical gastrectomy.
Classifying the complications after radical gastrectomy according to Clavien-Dindo classification is important for comparisons and quality assessments among different studies. And decreasing perioperative transfusion and avoiding combined multi-organ resection may reduce the incidence of postoperative complications and shorten the length of hospital stay.
根据Clavien-Dindo分类法探讨胃癌患者根治性胃切除术后的并发症，并研究并发症的主要危险因素。
2010年10月至2013年6月，湖南省肿瘤医院胃十二指肠胰腺外科共有614例行根治性胃切除术的患者，根据是否发生并发症分为两组（发生并发症组n = 76，占12.38%；未发生并发症组n = 538，占87.62%）。采用病例对照模型，对其年龄、性别、合并症、手术时间、术中失血量及病理分期等临床病理资料进行Logistic回归分析。
其中76例患者发生并发症（12.38%）。根据Clavien-Dindo分类法，Ⅱ、Ⅲ、Ⅳ、Ⅴ级并发症分别有56例（9.12%）、14例（2.28%）、3例（0.49%）和3例（0.49%）。与对照组相比，并发症组患者输血率更高（43.42%（n = 33） vs 24.16%（n = 130），P < 0.01），术后住院时间更长（（23±18）天 vs （14±6）天，P < 0.01）。两组患者的年龄、性别、体重指数（BMI）、清扫淋巴结数目、入院时血红蛋白和白蛋白水平、术中出血量、手术时间及病理TNM分期等方面比较，差异均无统计学意义（均P > 0.05）。单因素分析显示，BMI>25kg/m²、合并症、糖尿病、胃癌相关并发症、血红蛋白<100g/L、白蛋白<30g/L、腹水、全胃切除、联合多器官切除、手术时间>240分钟及围手术期输血与术后并发症相关（均P < 0.05）。进一步多因素分析显示，围手术期输血（OR = 2.78，95%CI：1.42 - 5.43，P < 0.01）和联合多器官切除（OR = 1.72，95%CI：1.14 - 2.58，P = 0.01）是根治性胃切除术后术后并发症的独立危险因素。
根据Clavien-Dindo分类法对根治性胃切除术后并发症进行分类，对于不同研究之间的比较和质量评估具有重要意义。减少围手术期输血并避免联合多器官切除可能会降低术后并发症的发生率并缩短住院时间。
