A O06 Impact of complications on survival and postoperative recovery using Comprehensive Complication Index versus Clavien-Dindo grading after laparoscopic and open D2-gastrectomy in the multicenter randomized LOGICA-trial

Abstract

Abstract Background Complications can be classified using the most-severe Clavien-Dindo-Classification (CDC) per patient or the total complication burden per patient expressed in the Comprehensive Complication Index (CCI). This study determined the additional value of CCI to CDC in examining the impact of complications after gastric cancer surgery. Methods The CCI and CDC were determined in the multicenter randomized LOGICA-trial comparing laparoscopic versus open D2-gastrectomy for cancer (cT1-4aN0-3M0). Differences in median CCI between laparoscopic and open gastrectomy were compared for overall postoperative complications, and infectious, gastrointestinal, pulmonary, and cardiovascular complications. CCI and CDC were correlated to hospitalization, ICU-stay and reoperations using Spearman’s rho-test, and compared with standard Fisher’s z-transformation. Results Between 2015-2018, 211 patients underwent laparoscopic (n=106) or open (n=105) D2-gastrectomy, and 157 (74%) received neoadjuvant chemotherapy. Median CCI was comparable between laparoscopic versus open gastrectomy regarding overall complications (CCI 0 [IQR 0-23.5] versus 0 [IQR 0-22.6]; p=0.755) and subgroups of complications (p>0.05). Both CCI and CDC showed moderate positive correlations for hospitalization (rs=0.646 versus rs=0.628; p=0.001, clinically irrelevant), and reoperations (rs=0.590 versus rs=0.599; p=0.070), and weak correlations for ICU-stay (rs=0.446 versus rs=0.440; p=0.189). Conclusions The CCI is a composite scoring system based on the CDC, and reflects a subjective interpretation of complication burden from the perspectives of both physicians and patients, after abdominal surgery other than gastrectomy. Implementation of CCI had no clinically relevant benefit and produced additional workload compared to CDC for assessing complication burden. Therefore, the use of CCI alongside the CDC after gastric cancer surgery is not recommended.