Huang Chang-Ming, Tu Ru-Hong, Lin Jian-Xian, Zheng Chao-Hui, Li Ping, Xie Jian-Wei, Wang Jia-Bin, Lu Jun, Chen Qi-Yue, Cao Long-Long, Lin Mi
From the Department of Gastric Surgery, Fujian Medical University Union Hospital, Fuzhou, Fujian Province, China.
Medicine (Baltimore). 2015 May;94(17):e812. doi: 10.1097/MD.0000000000000812.
To investigate the risk factors for postoperative complications following laparoscopic gastrectomy (LG) for gastric cancer and to use the risk factors to develop a predictive scoring system.Few studies have been designed to develop scoring systems to predict complications after LG for gastric cancer.We analyzed records of 2170 patients who underwent a LG for gastric cancer. A logistic regression model was used to identify the determinant variables and develop a predictive score.There were 2170 patients, of whom 299 (13.8%) developed overall complications and 78 (3.6%) developed major complications. A multivariate analysis showed the following adverse risk factors for overall complications: age ≥65 years, body mass index (BMI) ≥ 28 kg/m, tumor with pyloric obstruction, tumor with bleeding, and intraoperative blood loss ≥75 mL; age ≥65 years, a Charlson comorbidity score ≥3, tumor with bleeding and intraoperative blood loss ≥75 mL were identified as independent risk factors for major complications. Based on these factors, the authors developed the following predictive score: low risk (no risk factors), intermediate risk (1 risk factor), and high risk (≥2 risk factors). The overall complication rates were 8.3%, 15.6%, and 29.9% for the low-, intermediate-, and high-risk categories, respectively (P < 0.001); the major complication rates in the 3 respective groups were 1.2%, 4.7%, and 10.0% (P < 0.001).This simple scoring system could accurately predict the risk of postoperative complications after LG for gastric cancer. The score might be helpful in the selection of risk-adapted interventions to improve surgical safety.
探讨胃癌腹腔镜胃切除术（LG）术后并发症的危险因素，并利用这些危险因素建立预测评分系统。很少有研究旨在开发评分系统来预测胃癌LG术后的并发症。我们分析了2170例行胃癌LG患者的记录。采用逻辑回归模型确定决定因素变量并建立预测评分。共有2170例患者，其中299例（13.8%）发生总体并发症，78例（3.6%）发生严重并发症。多因素分析显示总体并发症的以下不良危险因素：年龄≥65岁、体重指数（BMI）≥28kg/m²、伴有幽门梗阻的肿瘤、伴有出血的肿瘤以及术中失血≥75mL；年龄≥65岁、Charlson合并症评分≥3、伴有出血的肿瘤以及术中失血≥75mL被确定为严重并发症的独立危险因素。基于这些因素，作者制定了以下预测评分：低风险（无危险因素）、中度风险（1个危险因素）和高风险（≥2个危险因素）。低、中、高风险组的总体并发症发生率分别为8.3%、15.6%和29.9%（P<0.001）；三组各自的严重并发症发生率分别为1.2%、4.7%和10.0%（P<0.001）。这种简单的评分系统可以准确预测胃癌LG术后的并发症风险。该评分可能有助于选择风险适应性干预措施以提高手术安全性。
