P159 the Impact of Postoperative Complications on Long-Term Survival and Disease Recurrence Following Oesophago-Gastric Cancer Resection

Abstract

Aim Postoperative complications following the resection of oesophago-gastric carcinoma can result in considerable early morbidity and mortality, however the long-term effects are less clear. Literature reports are mixed, so it remains unclear if complications reduce survival, as has been demonstrated in colorectal cancer. Background & Methods Some 1100 patients who underwent oesophago-gastric resection between 2006-16 were stratified by complication severity to determine the effect of leak and severe non-leak related complications on overall survival, recurrence and disease free survival. Results The median age was 69 years, 48% had stage III disease, with cancer recurrence in 39%. Clavien-Dindo (CD) complications ≥ III occurred in 22.2% of patients. The most common complications were pulmonary (30%), with a 13% incidence of pneumonia, 10% atrial dysrhythmia and 9.6% anastomotic leak. In comparison to CD 0-I complication free patients, those with CD III-IV leak did not suffer a significantly reduced survival. However patients with CD III-IV non-leak related complications were associated with a significant reduction in median overall survival (19.7 vs. 42.7 months) and disease free survival (18.4 vs. 36.4 months). Cox regression revealed age, stage, resection margin, and CD III-IV non-leak complications as independently associated with poor overall and disease free survival. Conclusion This cohort demonstrates that whilst leak does not affect long-term survival, other severe postoperative complications do significantly reduce overall survival and disease recurrence. A reduction in these complications, such as pneumonia, seen with adoption of hybrid / minimally invasive surgery may help change this pattern of disease recurrence and reduced survival.

Improved Mortality, Morbidity, and Long-Term Outcome After Anatomical Hepatectomy With the Glissonean Pedicle Approach in Patients With Hepatocellular Carcinoma

“…Morbidity after surgery was associated with worse long-term outcomes such as OS and RFS in patients with various cancers, such as esophageal cancers, colorectal cancers, and metastatic liver cancers 23–26 . Recently, similar results have been reported in patients with HCC who underwent hepatectomy.…”

Impact of anastomotic leak on long-term survival in patients undergoing gastrectomy for gastric cancer

“…Leakage associated with grade III-V complications, according to the Clavien-Dindo grading system 16,17 , was defined as severe AL, and that associated with less severe complications (grade I-II) as non-severe AL. All patients who died within 30 days of surgery were excluded from the adjusted analyses of long-term survival, consistent with previous studies 9,18 .…”

Laparoscopic Spleen-Preserving Hilar Lymphadenectomy for Advanced Proximal Gastric Cancer Without Greater Curvature Invasion

“…Multiple studies have also suggested that splenectomy is closely associated with increased postoperative complication rates and mortality, and postoperative complications, especially intra-abdominal infectious complications, can further affect the OS and DFS of patients with GC. [14][15][16] Therefore, based on the proficient mastering of LSPSHL, we conducted the Fuges-02 RCT to explore the specific efficacy of splenic hilum lymphadenectomy for patients when avoiding splenectomy. In addition, 85.2% of the patients enrolled in this study had stage II or III tumors, and the incidence rate of SHLN metastasis (13.3%) was higher than the rate of 2.4% reported in the JCOG0110 study.…”