Morbidity and mortality of laparoscopy-assisted gastrectomy with extraperigastric lymph node dissection for gastric cancer

Gastrectomy with extraperigastric lymph node dissection has not been generally acceptable because of increased morbidity and mortality in some Western countries. Recently, many surgeons have become interested in laparoscopic gastric surgery for malignant disease as well as benign lesions because laparoscopic surgery itself has been shown to have many advantages over open surgery. The aims of this study are to evaluate the incidence and nature of operative morbidity and mortality after laparoscopy-assisted gastrectomy (LAG) with extraperigastric lymph node dissection with respect to surgical experience and to identify factors predictive of complications and death. We reviewed the surgical outcomes of LAG with extraperigastric lymph node dissection in 140 consecutive gastric cancer patients. Clinicopathologic characteristics, operative outcomes, and postoperative morbidities and mortalities were compared after dividing the 140 patients into early (1-70) and late (71-140) groups. And risk factors for morbidity and mortality were identified by multivariate logistic regression analysis. The overall operative morbidity and mortality rates were 18.6% and 0.7%, respectively. Thirty postoperative complications occurred in 26 patients. The minor surgical complication rate in the late group was significantly lower than that in the early group (P = 0.0349). According to univariate and multivariate analyses to evaluate the independent predictor of a higher operative morbidity rate, no factor was significantly associated with operative morbidity. We conclude that LAG with extraperigastric lymph node dissection is a technically feasible and acceptable surgical modality for gastric cancer and low morbidity and mortality rates for this procedure can be accomplished by experienced laparoscopic gastric surgeons at large-volume hospitals.