Surgical Choice Of Laparoscopic Total Gastrectomy And Analysis Of Risk Factors Of Postoperative Complications

Objective:To analyze and compare the short-term clinical effects of laparoscopic total gastrectomy and laparoscopic-assisted total gastrectomy in the treatment of gastric cancer patients,and to analyze the risk factors of short-term complications after laparoscopic total gastrectomy.In order to help clinicians to choose a reasonable surgical method of laparoscopic total gastrectomy and reduce postoperative complications.Methods:A retrospective study was conducted to collect 119 patients with gastric cancer from the Department of Gastrointestinal Surgery,Yijishan Hospital,the First Affiliated Hospital of Wannan Medical College from January 2019 to December 2022.The patients were divided into TLTG（50 cases）and LATG（69 cases）according to different operation methods.Clinical medical records of 119 patients with gastric cancer were collected.（1）Baseline data such as sex,age,body mass index（BMI）,diabetes and hypertension;（2）Intraoperative data:intraoperative blood loss,total duration of operation,and number of intraoperative lymph nodes dissection;（3）Tumor pathological data:maximum tumor diameter,tumor site,tumor differentiation degree,tumor T stage,tumor N stage;（4）Postoperative data:duration of first postoperative ventilation,duration of postoperative hospitalization,duration of postoperative laparoscopic drainage catheter indwelling,incidence of postoperative complications（incision dehiscence,incision infection,anastomotic leakage,anastomotic stenosis,pulmonary infection,paralytic intestinal obstruction within 30 days after surgery）.SPSS26.0software was used to express the data of continuous variables conforming to normal distribution as mean±standard deviation（?X±S）,and independent sample t test was used for statistical analysis.Continuous variables that did not conform to the normal distribution were represented by M(P_25,P₇₅),and the Mann-Whitney U rank sum test was used for statistical analysis.Categorical variables were described by the number of cases（%）[example（%）],and the Chi-square or Fisher exact probability test was used for statistical analysis.Single factor was tested by Chi-square test or Fisher’s exact probability method,and P<0.05 was included in multivariate analysis.Binary Logistic regression model was used in multivariate analysis,and P<0.05 indicated statistically significant difference.Results:A total of 119 patients with gastric cancer who underwent laparoscopic total gastrectomy were included in this study,including 50 patients in the TLTG group and 69 patients in the LATG group.There were no significant differences in gender,age,BMI,hypertension,diabetes,operation time,number of lymph nodes dissection,maximum tumor diameter,tumor differentiation degree,tumor T stage,tumor N stage,total postoperative complication rate,postoperative indent abdominal drainage tube and postoperative hospital stay between the two groups（P>0.05）.The incision length in the TLTG group（4.00±0.46 cm）was smaller than that in the LATG group（8.59±0.65 cm）,and the difference was statistically significant（P<0.05）.The first postoperative ventilation time in the TLTG group[3（3,4）d]was less than that in the LATG group[5（5,6）d],and the difference was statistically significant（P<0.05）.The intraoperative blood loss in the TLTG group[125（100,140）ml]was less than that in the LATG group[150（140,180）ml],and the difference was statistically significant（P<0.05）.In the analysis of risk factors for postoperative complications,univariate analysis showed that BMI,operation time and diabetes were statistically significant（P<0.05）.Age,sex,hypertension,surgical method,intraoperative blood loss,tumor size,number of intraoperative lymph nodes dissection,degree of tumor differentiation,tumor site,T stage and N stage were not statistically significant（P<0.05）.BMI,operation time and diabetes in univariate analysis were included in binary logistic regression analysis,which showed that BMI（p=0.184）was not statistically significant.Operation time（>240 min）[P=0.020,OR=3.619,95%CI（1.226-10.684）]was statistically significant.Diabetes was not statistically significant（P=0.147）.Conclusions:For the two types of laparoscopic total gastrectomy,TLTG has advantages over LATG in terms of intraoperative blood loss,surgical incision length,and first postoperative gastrointestinal ventilation,and its minimally invasive effect is more obvious.Operative time（>240min）was an independent risk factor for postoperative complications after laparoscopic total gastrectomy.