Gastroenterol Res

Gastroenterology Research, ISSN 1918-2805 print, 1918-2813 online, Open Access

Article copyright, the authors; Journal compilation copyright, Gastroenterol Res and Elmer Press Inc

Journal website http://www.gastrores.org

Original Article

Volume 11, Number 3, June 2018, pages 213-220

Incidence, Causes and Risk Factors for 30-Day Unplanned Reoperation After Gastrectomy for Gastric Cancer: Experience of a High-Volume Center

**Table 1.** Clinicopathological Characteristics of the Entire Study Cohort Stratified by Undergoing Unplanned Reoperation or Not (n = 1,948)
Variables	Reoperation group (n = 24)	Non-reoperation group (n = 1,924)	χ² or t value	P value
^*Tumor stages are based on the seventh edition of the Union for International Cancer Control TNM classification.
Sex (male: female)	20:4	1,265:659	3.27	0.07
Age (years)	58.75 ± 10.00	55.20 ± 10.52	1.63	0.10
Body mass index (kg/m²)	21.51 ± 2.11	21.79 ± 2.98	0.46	0.65
American Society of Anesthesiologist score			1.74	0.19
1 + 2	19	1,693
3 + 4	5	231
Smoking history (yes: no)	13:11	812:1,112	1.39	0.24
Any comorbidities (yes: no)	6:18	577:1,347	0.28	0.60
History of abdominal surgery (yes: no)	4:20	192:1,732	1.17	0.28
Neoadjuvant chemotherapy (yes: no)	1:23	110:1,814	0.11	0.75
Preoperative albumin (g/L)	36.00 ± 5.09	38.13 ± 4.58	2.23	0.02
Preoperative hemoglobin (g/L)	118.63 ± 26.11	118.80 ± 24.45	0.03	0.97
Complication due to the tumor	6:18	429:1,495	0.10	0.75
Pyloric obstruction	6:18	254:1,670	2.85	0.09
Bleeding	1:23	191:1,733	0.89	0.50
Operation method			0.48	0.49
Open	22	1,671
Laparoscopy	2	253
Type of resection			2.72	0.10
Subtotal gastrectomy	15	1,478
Total gastrectomy	9	446
Additional organ resection			1.42	0.23
Yes	2	71
No	22	1,835
Combined multi-organ resection			26.58	< 0.001
Yes	7	99
No	17	1,825
Tumor size (cm)	5.24 ± 2.08	4.09 ± 2.05	2.74	0.006
Tumor location			6.26	0.1
Upper	3	158
Middle	5	396
Lower	13	1,301
Diffuse	3	69
Depth of invasion*			3.84	0.28
T1	1	367
T2	4	296
T3	1	111
T4	18	1,150
Lymph node metastasis*			1.21	0.75
N0	8	749
N1	3	324
N2	5	378
N3	8	473
pTNM stage*			3.02	0.22
I	4	489
II	3	414
III	17	1,021
Intraoperative blood loss (mL)	242.5 ± 158.6	203.9 ± 116.1	1.61	0.11
Operation time (min)	232.0 ± 46.7	200.9 ± 53.7	2.83	0.01
Perioperative blood transfusion (yes: no)	11:13	382:1,542	9.93	0.002
Morbidity (%)	9:15	131:1,793	33.47	< 0.001
Mortality (%)	2:22	6:1,918	37.29	< 0.001
Transferring to Intensive Care Unit post-operation	5:19	46:1,878	31.62	< 0.001
Postoperative hospital stays (days)	33.63±28.85	11.01 ± 4.86	19.12	< 0.001

Table 1. Clinicopathological Characteristics of the Entire Study Cohort Stratified by Undergoing Unplanned Reoperation or Not (n = 1,948)

Variables

Reoperation group (n = 24)

Non-reoperation group (n = 1,924)

χ² or t value

P value

^*Tumor stages are based on the seventh edition of the Union for International Cancer Control TNM classification.

Sex (male: female)

20:4

1,265:659

3.27

0.07

Age (years)

58.75 ± 10.00

55.20 ± 10.52

1.63

0.10

Body mass index (kg/m²)

21.51 ± 2.11

21.79 ± 2.98

0.46

0.65

American Society of Anesthesiologist score

1.74

0.19

1 + 2

1,693

3 + 4

231

Smoking history (yes: no)

13:11

812:1,112

1.39

0.24

Any comorbidities (yes: no)

6:18

577:1,347

0.28

0.60

History of abdominal surgery (yes: no)

4:20

192:1,732

1.17

0.28

Neoadjuvant chemotherapy (yes: no)

1:23

110:1,814

0.11

0.75

Preoperative albumin (g/L)

36.00 ± 5.09

38.13 ± 4.58

2.23

0.02

Preoperative hemoglobin (g/L)

118.63 ± 26.11

118.80 ± 24.45

0.03

0.97

Complication due to the tumor

6:18

429:1,495

0.10

0.75

Pyloric obstruction

6:18

254:1,670

2.85

0.09

Bleeding

1:23

191:1,733

0.89

0.50

Operation method

0.48

0.49

Open

1,671

Laparoscopy

253

Type of resection

2.72

0.10

Subtotal gastrectomy

1,478

Total gastrectomy

446

Additional organ resection

1.42

0.23

Yes

1,835

Combined multi-organ resection

26.58

< 0.001

Yes

1,825

Tumor size (cm)

5.24 ± 2.08

4.09 ± 2.05

2.74

0.006

Tumor location

6.26

0.1

Upper

158

Middle

396

Lower

1,301

Diffuse

Depth of invasion*

3.84

0.28

367

296

111

1,150

Lymph node metastasis*

1.21

0.75

749

324

378

473

pTNM stage*

3.02

0.22

489

414

III

1,021

Intraoperative blood loss (mL)

242.5 ± 158.6

203.9 ± 116.1

1.61

0.11

Operation time (min)

232.0 ± 46.7

200.9 ± 53.7

2.83

0.01

Perioperative blood transfusion (yes: no)

11:13

382:1,542

9.93

0.002

Morbidity (%)

9:15

131:1,793

33.47

< 0.001

Mortality (%)

2:22

6:1,918

37.29

< 0.001

Transferring to Intensive Care Unit post-operation

5:19

46:1,878

31.62

< 0.001

Postoperative hospital stays (days)

33.63±28.85

11.01 ± 4.86

19.12

< 0.001

**Table 2.** Clinical Courses From Gastrectomy to Treatment of Reoperation
No	Gastrectomy	Reconstruction	Interval(d)	Cause	Treatment	Morbidity
B-I: Billroth I reconstruction; B- II: Billroth II reconstruction; Roux-en-Y: Roux-en-Y reconstruction.
1	Distal sub-total	B-I	20	Wound dehiscence	Relaxation suture	None
2	Proximal sub-total	Gastroesophagal anastomosis	26	Adhesive intestinal obstruction	Enterolysis	None
3	Distal sub-total	B-I	7	Right gastro-omental vein bleeding	Suture	Intra-abdominal infection
4	Distal sub-total	B-I	15	Intra-abdominal infection	Debridement and drainage	Pleural effusion
5	Total	Roux-en-Y	12	Intra-abdominal infection	Debridement and drainage	None
6	Proximal sub-total	Gastroesophagal anastomosis	18	Wound dehiscence	Relaxation suture	None
7	Distal sub-total	B-I	14	Wound dehiscence	Relaxation suture	Intra-abdominal infection
8	Total	Roux-en-Y	11	Pancreatic fistula and intra-abdominal infection	Debridement and drainage	None
9	Distal sub-total	B-I	13	Adhesive intestinal obstruction	Enterolysis + intestine anastomosis	None
10	Distal sub-total	B-I	14	Gastroduodenal anastomosis leakage	Debridement and drainage	Sepsis and death
11	Distal sub-total	B-II	15	Wound dehiscence	Relaxation suture	Intra-abdominal infection
12	Distal sub-total	B-I	17	Adhesive intestinal obstruction	Enterolysis	Pulmonary infection
13	Distal sub-total	B-I	13	Adhesive intestinal obstruction	Enterolysis + intestine anastomosis	Intestine anastomosis leakage
14	Total	Roux-en-Y	11	Adhesive intestinal obstruction	Enterolysis	None
15	Distal sub-total	B-I	19	Wound dehiscence	Relaxation suture	None
16	Total	Roux-en-Y	10	Adhesive intestinal obstruction	Enterolysis	None
17	Total	Roux-en-Y	26	Obstructive jaundice due to common bile duct injury	Bovine Roux-en-Y anastomosis	DIC and death
18	Distal sub-total	B-I	0.1	Right gastric artery bleeding	Suture	None
19	Total	Roux-en-Y	0.1	Left gastro-omental vein bleeding	Suture	None
20	Total	Roux-en-Y	6	Liver section bleeding	Suture	None
21	Distal sub-total	B-I	3	Intra-abdominal bleeding (unexplained)	Exploratory	None
22	Distal sub-total	B-I	22	Intra-abdominal infection	Debridement and drainage	None
23	Total	Roux-en-Y	8	Adhesive intestinal obstruction	Enterolysis	None
24	Total	Roux-en-Y	22	Adhesive intestinal obstruction	Enterolysis + intestine anastomosis	Pulmonary infection and respiratory failure

Table 2. Clinical Courses From Gastrectomy to Treatment of Reoperation

Gastrectomy

Reconstruction

Interval(d)

Cause

Treatment

Morbidity

B-I: Billroth I reconstruction; B- II: Billroth II reconstruction; Roux-en-Y: Roux-en-Y reconstruction.

Distal sub-total

B-I

Wound dehiscence

Relaxation suture

None

Proximal sub-total

Gastroesophagal anastomosis

Adhesive intestinal obstruction

Enterolysis

None

Distal sub-total

B-I

Right gastro-omental vein bleeding

Suture

Intra-abdominal infection

Distal sub-total

B-I

Intra-abdominal infection

Debridement and drainage

Pleural effusion

Total

Roux-en-Y

Intra-abdominal infection

Debridement and drainage

None

Proximal sub-total

Gastroesophagal anastomosis

Wound dehiscence

Relaxation suture

None

Distal sub-total

B-I

Wound dehiscence

Relaxation suture

Intra-abdominal infection

Total

Roux-en-Y

Pancreatic fistula and intra-abdominal infection

Debridement and drainage

None

Distal sub-total

B-I

Adhesive intestinal obstruction

Enterolysis + intestine anastomosis

None

Distal sub-total

B-I

Gastroduodenal anastomosis leakage

Debridement and drainage

Sepsis and death

Distal sub-total

B-II

Wound dehiscence

Relaxation suture

Intra-abdominal infection

Distal sub-total

B-I

Adhesive intestinal obstruction

Enterolysis

Pulmonary infection

Distal sub-total

B-I

Adhesive intestinal obstruction

Enterolysis + intestine anastomosis

Intestine anastomosis leakage

Total

Roux-en-Y

Adhesive intestinal obstruction

Enterolysis

None

Distal sub-total

B-I

Wound dehiscence

Relaxation suture

None

Total

Roux-en-Y

Adhesive intestinal obstruction

Enterolysis

None

Total

Roux-en-Y

Obstructive jaundice due to common bile duct injury

Bovine Roux-en-Y anastomosis

DIC and death

Distal sub-total

B-I

0.1

Right gastric artery bleeding

Suture

None

Total

Roux-en-Y

0.1

Left gastro-omental vein bleeding

Suture

None

Total

Roux-en-Y

Liver section bleeding

Suture

None

Distal sub-total

B-I

Intra-abdominal bleeding (unexplained)

Exploratory

None

Distal sub-total

B-I

Intra-abdominal infection

Debridement and drainage

None

Total

Roux-en-Y

Adhesive intestinal obstruction

Enterolysis

None

Total

Roux-en-Y

Adhesive intestinal obstruction

Enterolysis + intestine anastomosis

Pulmonary infection and respiratory failure

**Table 3.** Univariate Analysis of Possible Predictors of Risk for unplanned Reoperation Following Gastrectomy for Gastric Cancer (n = 1948)
Variables	Reoperation group (n = 24)	Non-reoperation group (n = 1,924)	χ² value	P value
BMI: body mass index; ASA: American Society of Anesthesiologist.
Sex (male: female)	20:4	1,265:659	3.27	0.07
Age(years) ≥ 65/< 65	9:15	379:1,545	4.71	0.03
Age(years) ≥ 70/< 70	3:21	145:1,779	0.83	0.36
BMI (kg/m²) ≥ 25/< 25	1:23	272:1,652	1.96	0.16
ASA score ≥ 3/< 3	5:19	231:1,693	1.74	0.19
Comorbidity; yes/no	6:18	577:1,347	0.28	0.60
Smoking history; yes/no	13:11	812:1,112	1.39	0.24
History of abdominal surgery; yes/no	4:20	192:1,732	1.17	0.28
Neoadjuvant chemotherapy; yes/no	1:23	110:1,814	0.11	0.75
Preoperative albumin (g/L) <35/≥ 35	11:13	433:1,491	7.33	0.007
Preoperative hemoglobin (g/L) <100/≥ 100	6:18	401:1,523	0.25	0.62
Complication due to the tumor; yes/no	6:18	429:1,495	0.1	0.75
Operation method: open/laparoscopy	2:22	253:1,671	0.48	0.49
Extent of gastric resection: subtotal/total	15:9	1,478:446	2.72	0.10
Combined multi-organ resection; yes/no	7:17	99:1,825	26.58	< 0.001
Additional resection; yes/no	2:22	71:1,853	1.42	0.23
Intraoperative blood loss (mL): ≥ 300/< 300	5:19	399:1,525	0	0.99
Operation time (min): ≥ 240/< 240	15:9	427:1,497	21.95	< 0.001
Tumor size (cm); ≥ 5/< 5	15:9	699:1,225	6.99	0.008
Depth of invasion; T4/T1-3	18:6	1,150:774	2.29	0.13
Lymph node metastasis; positive/negative	16:8	1,175:749	0.31	0.58
TNM stage: III/I-II	17:7	1,021:903	3.01	0.08
Perioperative blood transfusion; yes/no	11:13	382:1,542	9.93	0.002

Table 3. Univariate Analysis of Possible Predictors of Risk for unplanned Reoperation Following Gastrectomy for Gastric Cancer (n = 1948)

Variables

Reoperation group (n = 24)

Non-reoperation group (n = 1,924)

χ² value

P value

BMI: body mass index; ASA: American Society of Anesthesiologist.

Sex (male: female)

20:4

1,265:659

3.27

0.07

Age(years) ≥ 65/< 65