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

Abstract

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.

Preoperative predictors of postoperative complications after gastric cancer resection

“…These complications can impede recovery, delay the initiation of adjuvant chemotherapy, and compromise quality of life [1,2]. Moreover, postoperative complications have been shown to adversely affect the overall and recurrence-free survival of patients after curative gastrectomy for gastric cancer; thus, some complications can be catastrophic for both short-and longterm outcomes [3][4][5]. The recently reported overall morbidity rates after resection for gastric cancer are 17.4-24.5% in East Asia and a slightly higher rate of 13.6-46% in Western countries [2,[6][7][8][9].…”

Propensity-score-matched analysis of a multi-institutional dataset to compare postoperative complications between Billroth I and Roux-en-Y reconstructions after distal gastrectomy

“…As a result, oncological outcomes were comparable between the two groups. A previous study indicates that postoperative complications have less adverse impact on prognosis of patients who underwent distal gastrectomy than those who underwent total gastrectomy [17].…”

“…We have recently reported that postoperative complications and delay in postoperative adjuvant chemotherapy adversely affected the prognosis in patients with gastric cancer [15,17]. In this study, we compared survivals between the R-Y and B-I groups.…”

“…linear and circular staplers) and laparoscopic surgery allow surgeons to select reconstruction methods with their discretion. In addition, worse perioperative course, more postoperative complications, and delayed postoperative adjuvant chemotherapy lead to worse prognosis in patients with gastric cancer [14][15][16][17]. Therefore, the clinical importance of preventing postoperative complications is increasing, and it is worthwhile to re-evaluate the differences in postoperative complications by reconstruction method after distal gastrectomy.…”

Short- and long-term outcomes associated with enhanced recovery after surgery protocol vs conventional management in patients undergoing laparoscopic gastrectomy

“…First, perioperative complications have been shown to be strongly associated with impaired long-term outcomes[ 26 , 27 ]. This could be the result of either delayed adjuvant chemoradiation or no adjuvant chemoradiation in complicated cases[ 28 ]. Moreover, ERAS protocols can bring potential benefits to advanced gastric cancer that may be related to a lower stress response and reduction in insulin resistance, which are considered to be factors associated with a good cancer long-term prognosis[ 29 - 31 ].…”