A scoring system to predict the risk of postoperative complications after laparoscopic gastrectomy for gastric cancer based on a large-scale retrospective study

Abstract

To investigate the risk factors for postoperative complications following laparoscopic gastrectomy (LG) for gastric cancer and to use the risk factors to develop a predictive scoring system. Few studies have been designed to develop scoring systems to predict complications after LG for gastric cancer. We analyzed records of 2170 patients who underwent a LG for gastric cancer. A logistic regression model was used to identify the determinant variables and develop a predictive score. There were 2170 patients, of whom 299 (13.8%) developed overall complications and 78 (3.6%) developed major complications. A multivariate analysis showed the following adverse risk factors for overall complications: age≥65 years, body mass index (BMI)≥28 kg/m2, tumor withpyloricobstruction, tumorwithbleeding,andintraoperativebloodloss ≥75mL; age ≥65 years, a Charlson comorbidity score ≥3, tumor with bleeding and intraoperative blood loss ≥75mL were identified as independent risk factors for major complications. Based on these factors, the authorsdeveloped the following predictivescore:lowrisk (no riskfactors), intermediate risk (1 risk factor), and high risk (≥2 risk factors).The overall complication rates were 8.3%, 15.6%, and 29.9%for the low-, intermediate-, and high-risk categories, respectively (P<0.001); the major complication rates in the 3 respective groups were 1.2%, 4.7%, and 10.0% (P<0.001). This simple scoring system could accurately predict the risk of postoperative complications after LG for gastric cancer. The score might be helpful in the selection of risk-adapted interventions to improve surgical safety.