Postoperative mortality and morbidity after D2 lymphadenectomy for gastric cancer: A retrospective cohort study

Table 1 Clinico-pathologic patient characteristics

Characteristics
Sex
Male	108	58.1%
Female	78	41.9%
Age, yr	64.9 ± 12.4	Range 24-90
Primary tumor location
Gastroesophageal junction	22	11.8%
Upper third	25	13.4%
Middle third	58	31.2%
Lower third	81	43.5%
Histological type (Lauren classification)
Enteric type	96	51.6%
Diffuse type	64	34.4%
Mixed type	26	14.0%
Type of resection
Total gastrectomy	88
Subtotal gastrectomy	98
Size, cm	4.4 ± 2.3	Range 0.5-14
Number of lymph nodes retrieved	38.3 ± 10.9	Range 17-98
Number of positive lymph nodes	4.1 ± 3.6	Range 0-39
Operation time, minutes	260 ± 76.1
Length of stay, d	12.7 ± 8.2
T status
T1a	36	19.3%
T1b	4	2.1%
T2	79	42.5%
T3	56	30.1%
T4a	2	1.1%
T4b	9	4.8%
Depth
Mucosa	14	7.5%
Submucosa	31	16.7%
Muscularis propria	37	19.9%
Subserosa (suspected invasion)	46	24.7%
Subserosa (certain invasion)	49	26.3%
Serosa	4	2.1%
Adjacent structures	5	2.7%
N status
N0	74	39.8%
N1	37	19.9%
N2	31	16.7%
N3a	33	17.7%
N3b	11	5.9%
Stage AJCC/TNM
IA	29	15.6%
IB	32	17.2%
IIA	34	18.3%
IIB	35	18.8%
IIIA	23	12.4%
IIIB	26	14.0%
IIIC	7	3.8%

Values are mean ± SD. All the patients were included in all evaluations.

Table 2 Mortality, overall morbidity and surgical morbidity in all patients

Characteristics	Number of cases	Mortality	Overall morbidity	Surgical morbidity
	186	7	40	17
Sex
Male	108	3	24	9
Female	78	4	16	8
		P = 0.4	P = 0.8	P = 0.7
Age
> 65 yr	80	7	22	10
≤ 65 yr	106	0	18	7
		P = 0.002	P = 0.1	P = 0.2
Type of surgery
TG	88	3	11	7
STG	98	4	29	10
		P = 1.0	P = 0.006	P = 0.6
Kattan score
≥ 100 points	121	7	32	14
< 100 points	65	0	8	3
		P = 0.09	P = 0.02	P = 0.1
Lymphadenectomy
> 35 lymph nodes	103	3	24	16
≤ 35 lymph nodes	83	4	16	1
		P = 0.7	P = 0.5	P = 0.0005
Lymph nodes
Negative	74	0	10	4
Positive	112	7	30	13
		P = 0.04	P = 0.04	P = 0.1
T
Early cancer	40	0	5	2
Advanced cancer	146	7	35	15
		P = 0.3	P = 0.1	P = 0.5
Splenectomy	105	4	24	9
Spleen-preserving	81	3	16	8
		P = 1.0	P = 0.7	P = 0.8

TG: Total gastrectomy; STG: Subtotal gastrectomy. All the patients were included in all evaluations. Fisher exact test two-tailed.

Table 3 Univariate and multivariate analysis of variables associated with postoperative mortality

	Univariate analysis			Multivariate analysis
	Number of cases	%	P value	T ratio	P value
Sex (Male)	3	42.9	0.406	0.5888	0.557
Age > 65 yr	7	100	0.008	2.960	0.004
Type of surgery (subtotal gastrectomy)	4	57.1	0.810
Kattan score ≥ 100	7	100	0.048	0.9504	0.343
Lymph nodes > 35	6	85.7	0.152	1.745	0.114
Primary site			0.821
Gastroesophageal junction	1	14.3
Upper third	1	14.3
Middle third	1	14.3
Lower third	4	57.1
Depth			0.137	1.231	0.220
Mucosa	0
Submucosa	1	14.3
Muscularis Propria	0
Subserosa (suspected invasion)	2	28.6
Subserosa (certain invasion)	3	42.9
Serosa	0
Adjacent structures	1	14.3
Histological type (Lauren classification)			0.436
Enteric type	3	42.9
Diffuse type	2	28.6
Mixed type	2	28.6
T status			0.031	1.342	0.181
T1a	0
T1b	0
T2	3	42.9
T3	2	28.6
T4a	0
T4b	2	28.6
Stage AJCC/TNM			0.039	0.6371	0.525
IA	0
IB	0
IIA	1	14.3
IIB	2	28.6
IIIA	1	14.3
IIIB	3	42.9
IIIC	0

Table 4 Major postoperative complications with a severity grade 2 or more according Clavien-Dindo classification

Type of complication	Number of cases	%
Pulmonary	12	6.4
Urinary tract infection	10	5.4
Leak of esophago-jejunal anastomosis	4	2.1
Intra-abdominal abscess	1	0.5
Abdominal bleeding	2	1.0
Duodenal fistula	5	2.7
Intestinal occlusion	2	1.0
Pancreatic fistula	4	2.1

Table 5 Clinicopathological factors associated with overall morbidity by univariate and multivariate analysis

	Univariate analysis			Multivariate analysis
	Number of cases	%	P value	T ratio	P value
Sex (Male)	24	60	0.779	0.8443	0.4
Age > 65 yr	22	55	0.575	0.4271	0.670
Type of surgery (subtotal gastrectomy)	29	72.5	0.005	2.526	0.012
Kattan score ≥ 100	32	80	0.026	0.5097	0.611
Lymph nodes > 35	24	60	0.962
Primary site			0.180	0.3756	0.708
Gastroesophageal junction	5	12.5
Upper third	1	2.5
Middle third	7	17.5
Lower third	27	67.5
Depth			0.017	0.2270	0.821
Mucosa	1	2.5
Submucosa	5	12.5
Muscularis propria	5	12.5
Subserosa (suspected invasion)	11	27.5
Serosa	3	7.5
Adjacent structures	4	10.0
Histological type (Lauren classification)			0.265	0.4180	0.677
Enteric	17	42.5
Diffuse	13	32.5
Mixed	10	25.0
T status			0.006	0.6177	0.538
1a	0
1b	5	12.5
2	15	37.5
3	12	30.0
4a	4	10.0
4b	4	10.0
Stage AJCC/TNM			0.018	0.8390	0.403
IA	5	12.5
IB	2	5.0
IIA	6	15.0
IIB	10	25.0
IIIA	7	17.5
IIIB	8	20.0
IIIC	2	5.0

AJCC: American Joint Committee on Cancer.

Table 6 Factors associated with surgical complications in univariate and multivariate analysis

	Univariate analysis			Multivariate analysis
	Number of cases	%	P value	T ratio	P value
Male sex	9	52.9	0.653	0.4193	0.675
Age > 65 yr	10	58.8	0.502	1.192	0.235
Type of surgery (subtotal gastrectomy)	10	58.8	0.595
Kattan score ≥ 100	14	82.3	0.116	0.08543	0.932
Lymph nodes > 35	16	94.1	0.002	3.222	0.001
Primary site			0.609
Gastroesophageal junction	4	23.5
Upper third	1	5.9
Middle third	2	11.8
Lower third	10	58.8
Depth			0.045	0.8208	0.413
Mucosa	0
Submucosa	2	11.8
Muscularis Propria	2	11.8
Subserosa (suspected invasion)	5	29.4
Subserosa (certain invasion)	3	17.6
Serosa	2	11.8
Adjacent structures	3	17.6
Histological type (Lauren classification)			0.817
Enteric type	8	47.1
Diffuse type	4	23.5
Mixed type	5	29.4
T status			0.054	1.102	0.272
T1a	0
T1b	2	11.8
T2	7	41.2
T3	4	23.5
T4a	1	5.9
T4b	3	17.6
Stage AJCC/TNM			0.019	0.8237	0.411
IA	1	5.9
IB	0
IIA	3	17.6
IIB	5	29.4
IIIA	3	17.6
IIIB	4	23.5
IIIC	1	5.9

AJCC: American Joint Committee on Cancer.