TABLE 3.
Perioperative Surgical Outcomes and Histopathologic Results After RAMIG (n=759)
| Entire cohort: n=759 | ||||
|---|---|---|---|---|
| Perioperative outcomes | Total gastrectomy, n=272 (100%) | Distal gastrectomy, n=465 (100%) | Proximal gastrectomy, n=22 (100%) | Missing values |
| Operating time, min, median [IQR] | 331 [275–390] | 270 [221–330] | 360 [314–428] | 29 (4) |
| Intraoperative blood loss, mL, median [IQR] | 120 [50–200] | 100 [50–200] | 38 [20–67] | 161 (21) |
| Textbook outcome* | 173 (64) | 338 (74) | 14 (64) | 6 (1) |
| Intraoperative complications | 0 | |||
| Any | 27 (10) | 27 (6) | 0 | |
| Conversion | 18 (7) | 17 (4) | 0 | |
| Bleeding | 5 (2) | 5 (1) | 0 | |
| Pancreatic injury | 0 | 0 | 0 | |
| Splenic injury | 1 (0.4) | 3 (0.6) | 0 | |
| Postoperative complications† | 5 (1) | |||
| Any complication | 114 (42) | 108 (23) | 8 (36) | |
| Anastomotic leakage | 27 (10) | 11 (2) | 4 (18) | |
| Duodenal stump leakage | 5 (2) | 4 (1) | 0 | |
| Pulmonary (including pneumonia)‡ | 47 (17) | 23 (5) | 5 (23) | |
| Cardiac (including atrial fibrillation)§ | 14 (5) | 12 (3) | 0 | |
| Ileus | 18 (7) | 12 (3) | 0 | |
| Intra-abdominal abscess | 11 (4) | 7 (2) | 1 (5) | |
| Wound complication | 5 (2) | 4 (1) | 0 | |
| Pancreatitis or pancreatic leakage/fistula | 2 (1) | 8 (2) | 0 | |
| Chyle leakage | 2 (1) | 2 (0.4) | 0 | |
| Postoperative bleeding requiring treatment | 2 (1) | 12 (3) | 1 (5) | |
| Clavien-Dindo grading (most severe complication) | 3 (0.4) | |||
| Grade 0 (no complications) | 157 (58) | 356 (77) | 14 (64) | |
| Grade 1 | 6 (2) | 10 (2) | 0 | |
| Grade 2 | 59 (22) | 45 (10) | 4 (18) | |
| Grade 3A | 22 (8) | 16 (4) | 3 (14) | |
| Grade 3B | 17 (6) | 23 (5) | 0 | |
| Grade 4A | 7 (3) | 6 (1) | 1 (5) | |
| Grade 4B | 3 (1) | 1 (0.2) | 0 | |
| Grade 5 (complication resulting in death) | 1 (0.4) | 3 (0.6) | 0 | |
| Radicality; resection margin status∥ | 14 (2) | |||
| R0 | 251 (93) | 437 (96) | 20 (91) | |
| R1 | 19 (7) | 16 (4) | 2 (9) | |
| Lymph node yield, nodes, median [IQR] | 31 [21–47] | 34 [24–47] | 34 [29–41] | 20 (3) |
| Nodal yield: 15 lymph nodes or more | 245 (92) | 430 (96) | 22 (100) | 22 (3) |
| Length of hospital stay, days, median [IQR] | 9 [7–14] | 9 [7–11] | 12 [8–21] | 5 (1) |
| Length of ICU admission, days, median [IQR] | 1 [0–2] | 0 [0–1] | 1 [1–2] | 8 (1) |
| ERAS protocol applied for recovery | 209 (84) | 250 (61) | 16 (84) | 80 (11) |
| Re-admissions within 30 days after discharge | 33 (12) | 29 (6) | 2 (9) | 28 (4) |
| Postoperative mortality at 30 days | 2 (1) | 6 (1) | 0 | 31 (4) |
Percentages may count ±100% due to rounding.
Textbook outcome was defined as a radical resection (R0), nodal yield ≥15 lymph nodes, no intraoperative complications, no postoperative complications ≥3b Clavien-Dindo grading, no reoperations, no ICU admission, hospital stay <21 days, and no 30-day mortality.
Postoperative complications were classified according to the definitions from the Gastrectomy Complications Consensus Group (GCCG).
Pneumonia occurred in 27 (10%), 10 (2%), and 2 (9%) patients after total, distal, and proximal gastrectomy.
Atrial fibrillation occurred in 12 (4%), 10 (2%), and 0 (0%) of patients after total, distal, and proximal gastrectomy.
Regarding all R1 resections (n=37), the Lauren histologic subtypes were subdivided in diffuse type (n=19; 63%) or intestinal/mixed type (n=11; 37%). The remaining 7 patients (19%) had unknown Lauren subtype and were regarded as missing for the histologic subtype.