Abstract
Background/Aims: Though laparoscopic assistant gastrectomy (LAG) of early gastric cancer (EGC) has become one of the most popular minimally invasive treatments of early gastric cancer, the frequency of postoperative complications did not decreased. The aim of this study is to find out the endoscopic role for the management of postoperative intraluminal complications of LAG. Methods: Clinical data of 392 patients who underwent LAG for EGC between Feb 2003 and Apr 2008 were enrolled and analyzed. Patient demographics, intraoperative complications, type of postoperative intraluminal complications, endoscopic treatment were examined. Statistical analysis were taken to find out the predictive factor for postoperative intraluminal complications. Results: Mean age of patients was 58 years and 250 (63.8%) were male. 352 (89.8%) had laparoscopic-assisted distal gastrectomy (LADG) and 40 (10.2%) underwent laparoscopic-assisted total gastrectomy (LATG). Anastomosis type were as follow; Roux-en-Y (52/13.3%), Billroth-I (213/54.3%), and Billroth-II (127/32.4%). 103 complications occurred in 69 patients (17.6%). The incidence of intraoperative complications, early (within 1 month), and late complication (after 1 month) were 4 (1%), 58 (14.8%), and 7 (1.8%), respectively. Endoscopic treatment was tried in 15 cases; intraluminal bleeding (11 cases), leakage (3 cases) and anastomotic stenosis (1 case). The endoscopic treatment was successful in 14 of 15 cases (93.3%) and failed in one case due to spurting Dieulafoy's ulcer bleeding. Intraluminal bleeding occurred frequently in older patients (p=0.031) and the risk of anastomosis leakage significantly increased in B-II (3.9%)/Roux-en-Y (5.5%), compared with B-I (0.5%) (p=0.013). Anastomosis stenosis occurred more frequently in LATG (7.1%) than in LADG (0.3%) (p=0.004) and also in Roux-en-Y (5.5%) than in B-I (0.5%)/B-II (0%) anastomosis (p=0.009). Conclusion: About 15% of postoperative complications of LAG is the indication that endoscopic treatment is needed. Intraluminal bleeding, anastomosis leakage, and stenosis after LAG of EGC could effectively be controlled with endoscopic treatment. The risk factors of these complications are LATG and Roux-en-Y anastomosis. So surgeons and endoscopists should pay attention to these conditions for prevention and management of postoperative intraluminal complications. Key word: laparoscopic gastrectomy, endoscopic treatment, intraluminal complications
Published Version
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