Anastomotic Leakage and Gastroparesis Syndrome Following Laparoscopic Radical Gastrectomy: A Retrospective Cohort Study Involving 3779 Patients.

Background and objectives: The occurrence of anastomotic leakage (AL) and gastroparesis syndrome (GS), common and severe complications after laparoscopic radical gastrectomy, significantly impacts the prognosis of patients. The objective of this study was to investigate the risk factors associated with AL after laparoscopic radical gastrectomy and GS after laparoscopic distal gastrectomy.

Methods: In this retrospective cohort study, 3779 patients who underwent laparoscopic radical gastrectomy and met the inclusion criteria were included. Of the 3779 patients, 85 (2.2%) were diagnosed with AL. The diagnosis of GS was made in 35 (2.4%) patients who underwent laparoscopic distal gastrectomy. Subsequently, univariate and multivariate logistic regression analyses were performed to determine the risk factors associated with AL and GS.

Results: The presence of hypoalbuminemia [odds ratio (OR)=2.437, 95% CI: 1.416-4.196, P=0.001] and intraoperative blood loss >150 ml (OR=1.712, 95% CI: 1.073-2.731, P=0.024) could be used as independent risk factors for AL. Total gastrectomy (OR=0.461, 95% CI: 0.264-0.805, P=0.006) and distal gastrectomy (OR=0.488, 95% CI: 0.276-0.863, P=0.014) were identified as the protective factors for AL. The presence of smoking history (OR=2.022, 95% CI: 1.022-4.001, P=0.043), pyloric obstruction (OR=3.748, 95% CI: 1.476-9.518, P=0.005), and Roux-en-Y anastomosis (OR=4.432, 95% CI: 1.292-15.206, P=0.018) were proved to be independently associated with GS for patients who underwent laparoscopic distal gastrectomy.

Conclusions: This study delineates distinct risk factors for AL and GS after laparoscopic gastrectomy. Contrary to preservation paradigms, total gastrectomy reduced AL risk versus proximal gastrectomy, challenging current proximal tumor management strategies.