Published online Jul 7, 2013. doi: 10.3748/wjg.v19.i25.4060
Revised: May 11, 2013
Accepted: May 18, 2013
Published online: July 7, 2013
Processing time: 166 Days and 15.4 Hours
AIM: To investigate the potential impact of complications in gastric cancer patients who survive the initial postoperative period.
METHODS: Between January 1, 2005 and December 31, 2006, 432 patients who received curative gastrectomy with D2 lymph node dissection for gastric cancer at our department were studied. Associations between clinicopathological factors [age, sex, American Society of Anesthesiologists grade, body mass index, tumor-node-metastases (TNM) stage and tumor grade], including postoperative complications (defined as any deviation from an uneventful postoperative course within 30 d of the operation and survival rates) and treatment-specific factors (blood transfusion, neoadjuvant therapy and duration of surgery). Patients were divided into 2 groups: with (n = 54) or without (n = 378) complications. Survival curves were compared between the groups, and univariate and multivariate models were conducted to identify independent prognostic factors.
RESULTS: Among the 432 patients evaluated, 61 complications occurred affecting 54 patients (12.50%). Complications included anastomotic leakages, gastric motility disorders, anastomotic block, wound infections, intra-abdominal abscesses, infectious diarrhea, bleeding, bowel obstructions, arrhythmias, angina pectoris, pneumonia, atelectasis, thrombosis, unexplained fever, delirium, ocular fungal infection and multiple organ failure. American Society of Anesthesiologists grade, body mass index, combined organ resection and median duration of operation were associated with higher postoperative complications. The 1-, 3- and 5-year survival rates were 83.3%, 53.2% and 37.5%, respectively. In the univariate analysis, the size of lesions, TNM stage, blood transfusion, lymphovascular invasion, perineural invasion, neoadjuvant chemotherapy, and postoperative complications were significant predictors of overall survival. In the multivariate analysis, only TNM stage and the presence of complications remained significant predictors of reduced survival.
CONCLUSION: The occurrence of in-hospital postoperative complications was an independent predictor of worse 5-year overall survival rate after radical resection of gastric cancer.
Core tip: The concept of perioperative complications as a risk factor for survival is well known in gastric cancer, however, the potential impact of complications for patients who survive the initial postoperative period has not been determined. We showed that the occurrence of in-hospital postoperative complications is an independent predictor of worse 5-year overall survival after radical resection of gastric cancer. In 432 patients evaluated, 61 complications occurred affecting 54 patients (12.50%). American Society of Anesthesiologists grade, body mass index, combined organ resection and median duration of operation were associated with higher postoperative complications. The 1-, 3- and 5-year survival rates were 83.3%, 53.2% and 37.5%, respectively.