Despite advances in surgical techniques, surgical morbidity and mortality remain important public health problems. Postoperative complications often lead to greater morbidity and mortality, as well as increased length of hospital stay and medical costs. Therefore, a reduction in postoperative complications is particularly important with regard to positive long-term outcomes in patients with cancer. To improve patients’ postoperative prognosis, it is necessary to screen for and focus on modifiable risk factors and their subsequent resolution. Recently, it was reported that nutritional status, inflammation and surgical approaches are related to postoperative morbidity and mortality. Therefore, in this review article, we describe the current evidence regarding modifiable risk factors influencing surgical morbidity and mortality as well as future directions for improved postoperative management in cancer patients.

Purpose: Despite the fact that there are several reports of single-port laparoscopic distal gastrectomy (SPDG), no analysis of its learning curve has been described in the literature. The aim of this study was to investigate the favorable factors for SPDG and to analyze the learning curve of SPDG. Materials and Methods: A total of 125 cases of SPDG performed from November 2011 to December 2015 were enrolled. All operations were performed by 2 surgeons (surgeon A and surgeon B). The moving average method was used for defining the learning curve. All cases were divided into 10 cases in a sequence, and the mean operative time and estimated blood loss data were extracted from each group. Results: Surgeon A performed 68 cases (female-to-male sex ratio, 91.1%: 8.82%), and surgeon B performed 57 cases (female-to-male sex ratio, 61.4%: 38.5%). The operative time of surgeon B significantly decreased after 30 cases (157.8 +/- 38.4 minutes vs. 118.1 +/- 34.5 minutes, P=0.003); that of surgeon A did not significantly decrease before and after around 30 cases (160.8 +/- 51.6 minutes vs. 173.3 +/- 35.2 minutes, P=0.6). The subgroup analysis showed that the operative time significantly decreased in the patients with body mass index (BMI) of <25 kg/m(2) (<25 kg/m(2):=25 kg/m(2), 159.3 +/- 41.7 minutes: 194.25 +/- 81.1 minutes; P=0.001). Conclusions: Although there was no significant decrease in the operative time for surgeon A, surgeon B reached the learning curve upon conducting 30 cases of SPDG. BMI of < 25 kg/m(2) was found to be a favorable factor for SPDG.