Clinicopathologic characteristics
Patients’ characteristics are summarized in Table 1. The study consisted of 82 men and 32 women with a mean age of 63.9 ± 10.5 years old. The preoperative mean BMI and Alb level of all patients were 22.6 ± 3.3 kg/m2 and 37.8 ± 3.6 g/L, respectively. The median preoperative hemoglobin concentration was 125.5 g/L [interquartile range (IQR) 103-141]. The number of patients with an ASA-graded physical status of 1, 2, or 3 were 13, 100 and 1, respectively. 20 patients received neoadjuvant chemo/chemoradiotherapy. The vast majority of patients underwent laparoscopic operation, only 6 patients received the combination surgery of laparoscopy and thoracoscopy. 98 patients underwent total gastrectomy and 3 patients of them performed combined resection of spleen or distal pancreas. The most frequent reconstruction technique of esophagojejunal anastomosis was end-to-side anastomosis with tubular stapler, and 48 patients received over-lap anastomosis using linear stapler. The median operation time and estimated blood loss were 335 minutes (IQR 315-360) and 100ml (IQR 50-200), respectively. 79 patients were diagnosed with Siewert type II AEG. The pathological stage of I, II, and III were 35, 25, and 54, respectively.
Table 1 Characteristics of the patients
Characteristic
|
Total N=114
|
No/minor complications n=93
|
Major complications
n=21
|
P-value
|
Age(years)
|
63.9±10.5
|
63.8±9.7
|
67.1±11.4
|
0.127
|
Sex
|
|
|
|
|
Male
|
82 (71.9)
|
67 (72.0)
|
15 (71.4)
|
0.955
|
Female
|
32 (28.1)
|
26 (28.0)
|
6 (28.6)
|
BMI(kg/m2)
|
22.6±3.3
|
22.3±3.6
|
24.5±2.7
|
0.003
|
ASA-PS 1/2/3
|
13/100/1
|
11/81/1
|
2/19/0
|
0.774
|
Preoperative albumin (g/L)
|
37.8±3.6
|
37.1±3.3
|
39.0±2.4
|
0.033
|
Preoperative hemoglobin (g/L)
|
125.5 (103-141)
|
123 (98-136)
|
132 (123-145)
|
0.003
|
Neoadjuvant chemoradiotherapy
|
Present
|
20 (17.5)
|
17 (18.3)
|
3 (14.3)
|
0.907
|
Absent
|
94 (82.5)
|
76 (81.7)
|
18 (85.7)
|
Approach method
|
|
|
|
|
Laparoscopy
|
108 (94.7)
|
88 (94.6)
|
20 (95.2)
|
0.669
|
Laparoscopy and thoracoscopy
|
6 (5.3)
|
5 (5.4)
|
1 (4.8)
|
Extent of resection
|
|
|
|
|
Total gastrectomy
|
96 (84.2)
|
83 (89.2)
|
13 (61.9)
|
0.006
|
Proximal gastrectomy
|
18 (15.8)
|
10 (10.8)
|
8 (38.1)
|
Combined resection
|
|
|
|
|
No
|
111 (97.4)
|
90 (96.8)
|
21 (100.0)
|
0.406
|
Yes
|
3 (2.6)
|
3 (3.2)
|
0
|
Reconstruction method of esophagojejunal anastomosis
|
Tubular
|
66 (57.9)
|
55 (59.1)
|
11 (52.4)
|
0.571
|
Linear
|
48 (42.1)
|
38 (40.9)
|
10 (47.6)
|
Operation time(min)
|
335 (315-360)
|
330 (300-348)
|
360 (335-465)
|
0.016
|
Estimated blood loss(ml)
|
100 (50-200)
|
100 (50-125)
|
100 (50-200)
|
0.100
|
Siewert Classfication I/II/III
|
0/79/35
|
0/62/31
|
0/17/4
|
0.308
|
Pathological stage I/II/III
|
35/25/54
|
29/23/41
|
6/2/13
|
0.224
|
Postoperative hospitalization duration
|
8 (7-12)
|
8 (7-9)
|
33 (18-43)
|
<0.001
|
BMI body mass index, ASA American Society of Anesthesiologists
Clinicopathologic characteristics
Patients’ characteristics are summarized in Table 1. The study consisted of 82 men and 32 women with a mean age of 63.9 ± 10.5 years old. The preoperative mean BMI and Alb level of all patients were 22.6 ± 3.3 kg/m2 and 37.8 ± 3.6 g/L, respectively. The median preoperative hemoglobin concentration was 125.5 g/L [interquartile range (IQR) 103-141]. The number of patients with an ASA-graded physical status of 1, 2, or 3 were 13, 100 and 1, respectively. 20 patients received neoadjuvant chemo/chemoradiotherapy. The vast majority of patients underwent laparoscopic operation, only 6 patients received the combination surgery of laparoscopy and thoracoscopy. 98 patients underwent total gastrectomy and 3 patients of them performed combined resection of spleen or distal pancreas. The most frequent reconstruction technique of esophagojejunal anastomosis was end-to-side anastomosis with tubular stapler, and 48 patients received over-lap anastomosis using linear stapler. The median operation time and estimated blood loss were 335 minutes (IQR 315-360) and 100ml (IQR 50-200), respectively. 79 patients were diagnosed with Siewert type II AEG. The pathological stage of I, II, and III were 35, 25, and 54, respectively.
Table 2 Diagnostic accuracy and the corresponding optimal cut-off value of different inflammatory markers
Variables
|
AUC
|
Cut-off Value
|
95% CI
|
P-Value
|
POD3 NEU
|
0.725
|
0.808
|
0.603-0.848
|
0.001
|
POD4 NEU
|
0.784
|
0.745
|
0.650-0.918
|
0.068
|
POD1 CRP
|
0.564
|
72.0
|
0.434-0.695
|
0.359
|
POD2 CRP
|
0.756
|
176.1
|
0.634-0.878
|
0.001
|
POD3 CRP
|
0.891
|
171.4
|
0.817-0.965
|
<0.001
|
POD2 PCT
|
0.651
|
1.110
|
0.525-0.778
|
0.041
|
POD3 PCT
|
0.677
|
1.320
|
0.549-0.805
|
0.065
|
POD3/2 CRP
|
0.903
|
1.160
|
0.814-0.993
|
<0.001
|
NEU neutrophils
Fig. 2 Receiver operating characteristics curve analysis of the ratio of CRP level on postoperative day 3 to day 2.
Predictive factors for major PCs
According to Table 1, age, BMI, preoperative albumin, preoperative hemoglobin, extent of resection and operation time were different significantly in two groups. However, preoperative hemoglobin was at normal range in both groups (123 vs. 132). Preoperative albumin was below the lowest reference value (37.1 vs. 39.0) in two groups. In addition, our study was short at sample size. Therefore, only age, BMI, extent of resection, operation time and classification of Siewert type were introduced into univariate and multivariate analyses. Among these factors, proximal gastrectomy [ odds ratio (OR) 8.224, 95% CI 1.976-34.234, p=0.004] and operation time no less than 360 minutes (OR 6.753, 95% CI 2.037-22.395, p=0.002) were identified as significant independent predictive factors for major postoperative complications after laparoscopic gastrectomy for AEG (Table 3).
Table 3 Univariate and multivariate analyses of clinical factors for major postoperative complications
|
Univariate analysis
|
|
Multivariate analysis
|
Characteristics
|
OR
|
95% CI
|
P-value
|
|
OR
|
95% CI
|
P-value
|
Age, ≥ 65 vs. <65 yr
|
1.113
|
0.368-3.365
|
0.850
|
|
0.697
|
0.193-2.523
|
0.582
|
BMI, ≥25 vs.<25 kg/m2
|
3.900
|
1.398-10.879
|
0.009
|
|
2.596
|
0.793-8.496
|
0.385
|
Extent of Resection, proximal vs. total
|
5.108
|
1,703-15.317
|
0.004
|
|
8.224
|
1.976-34.234
|
0.004
|
Operation time,
≥360 vs. <360 min
|
5.931
|
2.160-16.287
|
0.001
|
|
6.753
|
2.037-22.395
|
0.002
|
Siewert classification,
type II vs. type III
|
2.125
|
0.659-6.856
|
0.207
|
|
0.932
|
0.242-3.591
|
0.918
|
yr years old, OR odd ratio, CI confidence interval, BMI body mass index