Hiroaki Tanaka, MD, Kazuya Muguruma, MD, Katsunobu Sakurai, MD, Naoshi Kubo, MD, Hisashi Nagahara, MD, Eiji Noda, Yoshito Yamashita, MD, Kiyoshi Maeda, MD, Tetsuji Sawada, MD, Masaichi Ohira, MD, Kosei Hirakawa, MD. Department of Surgical Oncology, Osaka City University Graduate School of Medicine
INTRODUCTION: Laparoscopic-assisted gastrectomy (LAG) has been proposed as the promising therapy for early gastric cancer in Japan, because LAG has advantages such as less postoperative pain and an earlier recovery. Nevertheless, severe complication could be likely to occur and result poor outcome after LAG. This study investigated relationship of peripheral white blood cell (WBC) count and C-reactive protein (CRP) levels with the features of postoperative complications after LAG.
METHODS AND PROCEDURES: We analyzed data from 164 consecutive patients who underwent a LAG for gastric cancer at Osaka City University Hospital between 2006 and 2010. The patients’ clinicopathologic characteristics, surgical outcome, and blood test data after surgery were retrospectively examined from their medical records. Clinical characteristics included age, sex, underlying systemic disease, body mass index, operation time, blood loss, WBC count and CRP levels at postoperative day 1. The normal reference level were WBC 4300-8000, CRP 0-0.4mg/dl. The operations were performed for patients with gastric cancer invading the submucosal layer or lower, a D1 or D1+ lymph node dissection according to the Japanese Gastric Cancer Guidelines.
RESULTS: The mean age of the patients was 66 years. 77 patients had underlying diseases such as cerebrovascular disease, ischemic heart disease, hypertension, chronic obstructive lung disease and diabetes. The mean BMI was 22.3. Distal gastrectomy was performed in 148 patients, total gastrectomy in 10 and proximal gastrectomy in 4. Postoperative complications occurred in 14 (8.5%) patients: anastomotic leakage in 5, pancreatic fistula in 5, pneumonia in 1, and enterocolitis in 1. Univariate analysis revealed the presence of underlying disease and WBC CRP level at postoperative day 1 were risk factors for postoperative complications after LAG. Odds ratio of postoperative complications was 2.22 in patients with high WBC count (more than 9500) and high CRP (more than 6.5mg/dl).
CONCLUSION: Postoperative complications after LAG could be more likely to occur in patients with underlying systemic disease. To treat these patients with appropriate therapy, it is necessary to focus on WBC count and CRP level at postoperative day 1.
Session Number: Poster – Poster Presentations
Program Number: P553