General complications following laparoscopic-assisted gastrectomy and analysis of techniques to manage them

The aim of this study was to assess the complications associated with the laparoscopic treatment of gastric cancer and to discuss their management. From March 2004 to June 2007, 302 patients affected by gastric adenocarcinoma underwent laparoscopy-assisted gastrectomy. Of the 302 gastric malignancy cases, distal gastrectomy was performed in 161 cases, proximal gastrectomy in 62 cases, and total gastrectomy in 79 cases. In all cases, D1 or D2 lymph node dissection was performed according to the recommended procedures of the Japanese Gastric Cancer Association. Duration of surgery ranged from 180 to 310 min (median 230 min). There were no deaths during surgery and no anesthesiology complications in our series. We recorded 15 (4.97%) intraoperative complications: one transverse colon perforation, one lesion of the liver, two cases of splenic laceration, one injury of cystic artery leading to gangrene of the gallbladder, nine cases of hemorrhage, and one biliary tract injury. Conversion to open surgery was necessary in only five cases (1.7%). We recorded 21 (7.0%) postoperative complications: four cases of intra-abdominal bleeding, seven cases of duodenal stump leakage, one case of duodenal stump leakage followed by arteriole hemorrhage due to fundus of the stomach, two cases of acute pancreatitis, one case of lymphatic fistula, one case of anastomotic fistula, three cases of delayed gastric emptying, and two cases of obstruction of afferent loop. Six patients underwent reoperation, of whom two died after the procedure while the other four recovered postoperatively; other postoperative complications were treated conservatively. The overall operative morbidity and mortality rates were 11.9% and 0.7%, respectively. Our results show that laparoscopic-assisted gastrectomy is an adequate treatment for gastric cancer as long as the indications are controlled and only suitable cases are enrolled in the series. The complication rate is low enough to be acceptable. Most complications can be treated effectively via conservative treatment, and only a small number of cases require reoperation.