Does postoperative morbidity worsen the oncological outcome after radical surgery for gastrointestinal cancers? A systematic review of the literature

Abstract

PurposeThe impact of postoperative complications on survival after radical surgery for esophageal, gastric, and colorectal cancers remains controversial. We conducted a systematic review of recent publications to examine the effect of postoperative complications on oncological outcome.MethodsA literature search of PubMed/MEDLINE was performed using the keywords “esophageal cancer,” “gastric cancer,” and “colorectal cancer,” obtaining 27 reports published online up until the end of April 2016. Articles focusing on (i) postoperative morbidity and oncological outcome; and (ii) body mass index (BMI), postoperative morbidity, and oncological outcome, were selected. Univariate and multivariate analyses (Cox proportional hazards model) were performed.ResultsPatients with postoperative complications had significantly poorer long‐term survival than those without complications. Complications were associated with impaired oncological outcomes. The hazard ratios for overall survival were 1.67 (95% confidence interval [CI], 1.31‐2.12), 1.59 (95% CI, 1.13‐2.24), and 1.55 (95% CI, 1.28‐1.87) in esophageal, gastric, and colorectal cancers, respectively. High BMI was associated with postoperative morbidity rate but not with poor oncological outcome. Low BMI was significantly associated with inferior oncological outcome.ConclusionsComplications after radical surgery for esophageal, gastric, and colorectal cancers are associated with patient prognosis. Avoiding such complications might improve the outcomes.

Multi‐institutional analysis of the prognostic significance of postoperative complications after curative resection for gastric cancer

“…The adverse effect of complications after cancer surgery on survival has been reported in several solid malignancies, including colorectal and head and neck cancer as well as gastric cancer . For example, Tokunaga et al analyzed 765 patients and found that grade 2 or higher intra‐abdominal infectious complications after radical resection of gastric cancer adversely affect survival .…”

“…The adverse effect of complications after cancer surgery on survival has been reported in several solid malignancies, including colorectal and head and neck cancer as well as gastric cancer. 7,[17][18][19] For example, Tokunaga et al analyzed 765 patients and found that grade 2 or higher intra-abdominal infectious complications after radical resection of gastric cancer adversely affect survival. 5 A propensity score matching was conducted by Fujiya et al to assess the prognostic F I G U R E 3 Significance of the association of postoperative complications with recurrence-free survival impact of postoperative intra-abdominal infectious complications graded 2 or higher, and they found that overall (HR 1.43) and recurrence-free survival (HR 1.42) survival were significantly shortened in patients with complications.…”

“…Furthermore, evidence indicates postoperative complications significantly correlated to subsequent poor prognosis . Unfortunately, there is controversy over the evidence supporting the prognostic significance of postoperative complications . For example, previous studies often suffer from small sample size, data from a single‐institution, limited information on adjuvant treatment, and a prolonged period of time to acquire data leading to time‐dependent transition of standard treatment .…”

“…5,6 Unfortunately, there is controversy over the evidence supporting the prognostic significance of postoperative complications. 7 For example, previous studies often suffer from small sample size, data from a single-institution, limited information on adjuvant treatment, and a prolonged period of time to acquire data leading to time-dependent transition of standard treatment. [8][9][10] Moreover, little is known about the correlations between types and severity of complications with prognosis as well as how complications affect the quality of adjuvant treatment.…”

Clinical impact of D3 lymph node dissection with left colic artery (LCA) preservation compared to D3 without LCA preservation: Exploratory subgroup analysis of data from JCOG0404

“…As previous studies reported, fewer postoperative complications might contribute to a better prognosis. 11,12 Although the number of harvested lymph nodes in D3 with LCA preservation was lower than that in D3 without LCA preservation, we considered it sufficient to dissect D3 lymph nodes oncologically through D3 with LCA preservation because the present study revealed the non-inferiority of D3 with LCA preservation in terms of prognosis compared with D3 dissection without LCA preservation. Although it is unknown whether the D3 lymph node dissection is necessary or not, JSCCR guideline recommends the D3 lymph node dissection.…”