The Depth from the Skin to the Celiac Artery Measured Using Computed Tomography is a Simple Predictive Index for Longer Operation Time During Laparoscopic Distal Gastrectomy

Background: Body mass index (BMI) is commonly used to classify obesity. However, BMI does not always reflect the degree of visceral fat. This study aimed to clarify the usefulness of measuring the depth from the skin to the celiac artery using computed tomography, as a simple predictive index for longer operation time during laparoscopic distal gastrectomy (LDG).

Methods: From September 2012 to March 2016, 66 patients who underwent LDG with D1+ lymph node dissection were included. The depth from the skin to the bifurcation of the celiac artery was defined as 'skin-to-celiac artery distance (SCD).' The patients were divided into two groups based on the median operation time. [Time scenarios from omentum incision to specimen extirpation and infrapyloric and suprapancreatic lymph node dissections (I-LND, S-LND) were assessed.] The factors eliciting a longer operation time than the median operation time were investigated.

Results: From omentum incision to specimen extirpation, BMI, thickness of subcutaneous fat (TSF), and SCD (P = 0.002, P = 0.039, P < 0.001) were the factors associated with longer operation time. Furthermore, BMI, TSF, and SCD in I-LND (P = 0.008, P = 0.022, P < 0.001) and BMI and SCD in S-LND (P < 0.001, P < 0.001) were associated with longer operation time. The multivariate analysis showed that a long SCD was the only significant independent factor to predict an operation time longer than the median operation time (P = 0.001). The best cutoff level of SCD calculated using the receiver operating characteristic curve was 88 mm.

Conclusions: This study demonstrated that SCD is a simple predictive index for longer operation time during LDG.