Long-Term Survival in Patients with Postoperative Intra-Abdominal Infectious Complications After Curative Gastrectomy for Gastric Cancer: A Propensity Score Matching Analysis

Fujiya, Keiichi; Tokunaga, Masanori; Mori, Keita; Makuuchi, Rie; Takeda, Yutaka; Bando, Etsuro; Kawamura, Taiichi; Terashima, Masanori

doi:10.1245/s10434-016-5577-5

Cited by 58 publications

(51 citation statements)

References 29 publications

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“…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. 9 These results are consistent with those of the present study that focused exclusively on intra-abdominal infectious complications.…”

Section: Discussionsupporting

confidence: 93%

“…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 . A propensity score matching was conducted by Fujiya et al to assess the prognostic 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 . These results are consistent with those of the present study that focused exclusively on intra‐abdominal infectious complications.…”

Section: Discussionsupporting

confidence: 89%

“…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 . 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.…”

Section: Introductionmentioning

confidence: 99%

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

et al. 2019

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Background Insufficient data are available on the prognostic significance of complications after resection of gastric cancer. Therefore, we aimed to assess this gap in our knowledge by studying patients with resectable gastric cancer. Methods A multi‐institutional retrospective database comprising clinical information of 3575 patients who received resection of gastric cancer from 2010 to 2014 at nine institutions. Grades 2 or greater complications of the Clavien‐Dindo classification were judged as clinically relevant postoperative complications, and their associations with postoperative survival were assessed. We assessed the effect of complications on times of initiation and continuation of postoperative adjuvant chemotherapy by S‐1. Results A total of 2954 patients were included in the analysis. Clinically relevant postoperative complications occurred in 664 (23%) patients. Patients’ recurrence‐free survival rate incrementally decreased as the grade of complications became greater. Patients with abdominal complications (eg, leakage of pancreatic fluids, intra‐abdominal abscess, and anastomotic leakage) and those with nonabdominal complications (eg, pneumonia) experienced worse recurrence‐free survival compared to those without complications. Patients who had complications were generally at greater risk of disease recurrence, except for those who underwent laparoscopic surgery and those with pathological stage I. Delayed initiation and shorter continuation of adjuvant S‐1 chemotherapy was experienced by patients with postoperative complications. Conclusions Postoperative complications adversely affected the prognosis in patients with resectable gastric cancer.

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Section: Discussionsupporting

confidence: 93%

Section: Discussionsupporting

confidence: 89%

Section: Introductionmentioning

confidence: 99%

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

et al. 2019

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“…If it is true that the incidence of postoperative complication is lower after RG than LG thanks to more meticulous procedures with articulated forceps, patients receiving RG might be able to receive adjuvant chemotherapy earlier and dose intensity might be higher, possibly resulting in improved long-term survival. In addition, considering the recently reported relationship between severe intra-abdominal infectious complication and poor long-term survival, RG could improve long-term survival by reducing postoperative complications (61,62).…”

Section: Discussionmentioning

confidence: 99%

Robotic gastrectomy for gastric cancer

Tokunaga

Kaito

Sugita

et al. 2017

Transl. Gastroenterol. Hepatol.

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Correspondence to: Masanori Tokunaga. 6-5-1, Kashiwanoha, Kashiwa, 277-8577 Japan. Email: mtokunag@east.ncc.go.jp.Abstract: The number of robotic gastrectomy (RG) performed per year has been increasing, particularly in East Asia where the incidence of gastric cancer is high and approximately half of the cases are diagnosed as early gastric cancer. With articulated devices of RG, surgeons are able to perform every procedure more meticulously, which can result in less bleeding and damage to organs. There are many single arm and comparative studies, and these study showed similar trends, which included relatively less estimated blood loss and longer operation time following RG than laparoscopic gastrectomy (LG), equivalent number of harvested lymph nodes and similar length of postoperative hospital stay between RG and LG. Considering the results of these retrospective comparative studies, RG seems to be as feasible as LG in terms of early surgical outcomes. However, medical expense of RG is approximately twice as much as that of LG. Lack of solid evidence in terms of long-term outcomes is another problem. Considering the higher medical expenses associated with RG, its superiority in terms of long-term survival outcomes needs to be confirmed in the future for it to be accepted more widely.

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“…The lymph node dissection combined with gastrectomy is considered as the only possibility of curative treatment for gastric cancer (GC) until now. Although surgical techniques and perioperative care had lots of improvements in the past decades, extensive surgery still be associated with considerable post‐operative complications which is harmful to post‐operative recovery and long‐term survival . Various risk factors, including age, surgical complexity, nutritional status, systemic inflammatory indexes, have been applied to predict post‐operative complications after gastrectomy of GC .…”

Section: Introductionmentioning

confidence: 99%

Change in serum albumin level predicts short‐term complications in patients with normal preoperative serum albumin after gastrectomy of gastric cancer

Sun

Liu

et al. 2019

ANZ Journal of Surgery

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Background The purpose of this study was to evaluate the correlation between serum albumin level change (ΔALB) and post‐operative complications in patients with normal preoperative serum albumin after gastrectomy of gastric cancer. Methods A total of 193 patients undergoing curative (R0) gastrectomy from September 2015 to May 2017 were enrolled in this study. The risk factors for predicting post‐operative complications were identified by univariate and multivariate analysis. The cut‐off value and diagnostic accuracy of ΔALB were measured by receiver operating characteristic curves. ΔALB was defined as: (albumin level before surgery − albumin on post‐operative day (POD) 1)/albumin level before surgery × 100%. Results A total of 60 patients (31.0%) had post‐operative complications. Our results showed that the cut‐off value of ΔALB was 19.0%. Using a cut‐off value of 19.0%, multivariate analysis identified that ΔALB was able to predict post‐operative complications as an independent factor (odds ratio 13.98, 95% confidence interval 6.048–32.32, P < 0.001). In addition, the area under the curve of ΔALB is higher than C‐reactive protein on POD 3 (0.773 versus 0633). Compared with patients with ΔALB <19.0%, patients with ΔALB ≥19.0% have higher risk of post‐operative complications suffered (62.3 versus 13.7%, P < 0.001) and longer post‐operative stay (22.1 ± 13.5 versus 17.5 ± 4.2, P < 0.001). Conclusion ΔALB acted as an independent predictor in short‐term complications for patients with normal preoperative serum albumin and its diagnostic accuracy was higher than C‐reactive protein on POD 3. It is promising to be a precise and straight predictor for incidence of post‐operative complications to patients with normal preoperative serum albumin.

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Long-Term Survival in Patients with Postoperative Intra-Abdominal Infectious Complications After Curative Gastrectomy for Gastric Cancer: A Propensity Score Matching Analysis

Cited by 58 publications

References 29 publications

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

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

Robotic gastrectomy for gastric cancer

Change in serum albumin level predicts short‐term complications in patients with normal preoperative serum albumin after gastrectomy of gastric cancer

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