Impact of postoperative complications on long-term survival after radical resection for gastric cancer

Table 1 Intergroup comparison of epidemiological and treatment-related variables in 432 patients

Variable	Postoperative	No postoperative	P value
	complications	complications
	(n = 54)	(n = 378)
Age (yr), median (range)	60 (28-80)	59 (23-76)	0.5161
Sex			0.2362
Male	37	226
Female	17	152
ASA grade			0.0002
I	24	341
II	18	33
III	11	4
IV	1	0
Body mass index (kg/m2)			0.0402
< 28	42	332
≥ 28	12	46
TNM stage			0.3582
I	5	49
II	9	94
III	28	174
IV	12	61
Tumor size (cm), mean (range)	4.9 (2.0-12.0)	4.7 (0.5-12.0)	0.3381
Combined organ resection			0.0002
No	35	346
Yes	19	32
Neoadjuvant therapy			0.1262
No	50	366
Yes	4	12
Median (range) duration of operation (min)	220 (175-310)	195 (160-300)	0.0001

¹t test;

²Pearson χ². ASA: American Society of Anesthesiologists; TNM: Tumor-node-metastases.

Table 2 Post-operative complication types, frequencies and severities

Variables	Number
Gastric resection-related complications
Anastomotic leakages	5
Gastric motility disorders	4
Anastomotic block	1
Infectious complications
Wound infection	7
Intra-abdominal abscess	5
Infectious diarrhea	1
Bleeding complications
Anastomotic bleeding	2
Intra-abdominal bleeding	5
Subcutaneous hematoma surrounding drainage tubes	1
Bowel obstructions	6
Pulmonary complications
Pneumonia	10
Atelectasis	1
Cardiac complications
Arrhythmia	4
Angina pectoris	1
Thrombosis
Deep venous thrombosis	1
Portal venous thrombosis	1
Other complications
Delirium	2
Unexpected fever	2
Ocular fungal infection	1
Multiple-organ failure	1
Incidence and severity (Clavien-Dindo grade)
I	8
II	35
IIIa	11
IIIb	2
IVa	1
IVb	1
V	3

Table 3 Univariate survival analysis of gastric cancer patients according to various clinicopathological variables and complications

Variable	Patients	5-yr survival	Log rankχ2test	P value
Gender			2.847	0.092
Male	262	34.00%
Female	167	43.70%
Age (yr)			1.157	0.282
≤ 60	230	40.00%
> 60	199	35.20%
BMI (kg/m2)			0.018	0.893
≤ 26	278	38.50%
> 26	151	36.40%
Size of lesions (cm)			8.130	0.004
< 5	269	42.00%
≥ 5	160	30.60%
TNM stage			60.453	0.000
I	54	72.20%
II	101	54.90%
III	202	28.70%
IV	72	12.70%
Blood transfusion			4.982	0.026
Yes	74	27.00%
No	355	40.00%
Lymphovascular invasion			4.673	0.031
Yes	69	21.70%
No	360	40.80%
Perineural invasion			5.237	0.022
Yes	36	25.00%
No	393	38.90%
Neoadjuvant chemotherapy			7.124	0.008
No	411	38.60%
Yes	18	16.70%
Complications			25.946	0.000
Yes	51	21.80%
No	378	39.90%

BMI: Body mass index; TNM: Tumor-node-metastases.

Table 4 Predictors of survival: Multivariate analysis

Risk factor	HR (95%CI)	P value
Size of lesions	1.2 (0.9-1.5)	0.156
TNM stage	1.6 (1.4-1.9)	0.000
Blood transfusion	0.9 (0.5-1.4)	0.752
Lymphovascular invasion	1.0 (0.6-1.6)	0.841
Perineural invasion	0.7 (0.4-1.0)	0.107
Neoadjuvant chemotherapy	1.5 (0.8-2.5)	0.134
Post-operative complications	2.5 (1.8-3.6)	0.000

Cox regression analysis of patient survival. TNM: Tumor-node-metastases.