Use of the modified Clavien‑Dindo classification to determine the risk factors for early complications following radical gastrectomy and the effect of such complications on long‑term prognosis

Abstract

Surgical resection remains the gold standard treatment for gastric cancer; however, the rate of post-operative complications remains unsatisfactory. Although the majority of complications are treatable, it remains unknown whether the long-term survival of patients is affected and what type of complications affect prognosis. In the present study, the modified Clavien-Dindo classification system was used to examine the incidence of early complications along with the related risk factors following radical gastrectomy (RG) and to determine the effects of such complications on long-term prognosis. For this purpose, 525 gastric cancer patients with RG were analyzed retrospectively. The results revealed that age [odds ratio (OR), 1.781; P=0.013], pre-operative comorbidity (OR, 1.765; P=0.020), blood loss (OR, 2.153; P=0.001) and the type of surgery (OR, 3.137; P<0.001) were identified as independent risk factors associated with post-surgery complications. Blood loss (OR, 13.053; P=0.013) and the resection type (OR, 7.936; P= 0.047) were identified as independent risk factors for severe complications. The 5-year overall survival (OS) rate of patients in the severe complication group was 35%, which was significantly worse than that of patients in the non-severe complication group (61.8%). Severe complications (hazard ratio, 1.595; P=0.107) were not found to be independent risk factors associated with the 5-year OS. On the whole, the present study demonstrates that complications following RG were significantly related to age, pre-operative comorbidity, blood loss and the type of surgery. Severe complications were distinctly affected by blood loss and the resection type. The 5-year OS of patients in the severe complication group was significantly worse than that of patients in the non-severe complication group; however, severe complications were not found to be independent risk factors associated with long-term survival.

Evaluation of respiratory exchange ratio (RER) for predicting postoperative outcomes in elderly patients undergoing oncological resection for gastrointestinal malignancies – A prospective cohort study

“…All observed complications in the postoperative period were defined and classified as per the modified Clavien–Dindo classification system, wherein score 1 indicates any deviation from the postoperative course, score 2 is given for any complication requiring pharmacological support, score 3 indicates the required surgical or radiological intervention, score 4 is given for any life-threatening complication requiring ICU support or organ dysfunction, and patient demise was considered as score 5, until the seventh postoperative day by an ICU physician blinded to the intraoperative data. [ 9 ] The total duration of ICU and hospital stay was also recorded.…”