Goto Hironobu, Kanaji Shingo, Yasuda Takashi, Oshikiri Taro, Yamamoto Masashi, Matsuda Takeru, Nakamura Tetsu, Suzuki Satoshi, Fujino Yasuhiro, Tominaga Masahiro, Kakeji Yoshihiro
Division of Gastrointestinal Surgery, Department of Surgery, Graduate School of Medicine, Kobe University, 7-5-2, Kusunoki-cho, Chuo-ku, Kobe City, Hyogo, 650-0017, Japan.
Division of Gastroenterological Surgery, Hyogo Cancer Center, Akashi City, Hyogo, Japan.
World J Surg. 2018 Apr;42(4):1065-1072. doi: 10.1007/s00268-017-4282-2.
Body mass index (BMI) is commonly used to classify obesity. However, BMI does not always reflect the degree of visceral fat. This study aimed to clarify the usefulness of measuring the depth from the skin to the celiac artery using computed tomography, as a simple predictive index for longer operation time during laparoscopic distal gastrectomy (LDG).
From September 2012 to March 2016, 66 patients who underwent LDG with D1+ lymph node dissection were included. The depth from the skin to the bifurcation of the celiac artery was defined as 'skin-to-celiac artery distance (SCD).' The patients were divided into two groups based on the median operation time. [Time scenarios from omentum incision to specimen extirpation and infrapyloric and suprapancreatic lymph node dissections (I-LND, S-LND) were assessed.] The factors eliciting a longer operation time than the median operation time were investigated.
From omentum incision to specimen extirpation, BMI, thickness of subcutaneous fat (TSF), and SCD (P = 0.002, P = 0.039, P < 0.001) were the factors associated with longer operation time. Furthermore, BMI, TSF, and SCD in I-LND (P = 0.008, P = 0.022, P < 0.001) and BMI and SCD in S-LND (P < 0.001, P < 0.001) were associated with longer operation time. The multivariate analysis showed that a long SCD was the only significant independent factor to predict an operation time longer than the median operation time (P = 0.001). The best cutoff level of SCD calculated using the receiver operating characteristic curve was 88 mm.
This study demonstrated that SCD is a simple predictive index for longer operation time during LDG.
体重指数（BMI）常用于对肥胖进行分类。然而，BMI并不总能反映内脏脂肪的程度。本研究旨在阐明使用计算机断层扫描测量从皮肤到腹腔动脉的深度作为腹腔镜远端胃癌切除术（LDG）中手术时间延长的简单预测指标的实用性。
纳入2012年9月至2016年3月期间接受D1 + 淋巴结清扫的LDG患者66例。从皮肤到腹腔动脉分叉处的深度定义为“皮肤至腹腔动脉距离（SCD）”。根据中位手术时间将患者分为两组。[评估从大网膜切开到标本切除以及幽门下和胰上淋巴结清扫（I-LND，S-LND）的时间情况。]研究导致手术时间长于中位手术时间的因素。
从大网膜切开到标本切除，BMI、皮下脂肪厚度（TSF）和SCD（P = 0.002，P = 0.039，P < 0.001）是与手术时间延长相关的因素。此外，I-LND中的BMI、TSF和SCD（P = 0.008，P = 0.022，P < 0.001）以及S-LND中的BMI和SCD（P < 0.001，P < 0.001）与手术时间延长相关。多变量分析显示，长SCD是预测手术时间长于中位手术时间的唯一显著独立因素（P = 0.001）。使用受试者工作特征曲线计算的SCD最佳截断水平为88 mm。
本研究表明，SCD是LDG手术时间延长的简单预测指标。
