A risk prediction system of postoperative hemorrhage following laparoscopy-assisted radical gastrectomy with D2 lymphadenectomy for primary gastric cancer

Objectives To investigate risk factors of postoperative hemorrhage (PH) following laparoscopy-assisted radical gastrectomy (LARG) with D2 lymphadenectomy for primary gastric cancer (PGC) and to use those risk factors to develop a scoring system for risk assessment. Materials and Methods A total of 1789 PGC patients were enrolled in our study. We analyzed the risk factors of PH and constructed a scoring system using 75% of the cases as the experimental group and 25% of the cases as a verification group to demonstrate the effectiveness. Results Among these 1789 patients, 46 (2.6%) developed PH. Univariate and multivariate analysis in the experimental group indicated that having more than 41 lymph node excisions, combined organ resection, stage III tumor and postoperative digestive fistula were independent risk factors of PH. According to the independent risk factors, we constructed a scoring system to separate patients into low-risk (0-2 points) and high-risk (≥ 3 points) groups. The area under the ROC curve for this scoring system was 0.748. In the verification group, the risk of PH predicted by the scoring system was not significantly different from the actual incidence observed. Conclusions This scoring system could simply and effectively predict the occurrence of PH following LARG with D2 lymphadenectomy for PGC. The predictive system will help surgeons evaluate risk and select risk-adapted interventions to improve surgical safety.