Abstract
BackgroundInsufficient data are available on the prognostic significance of complications after resection of gastric cancer. Therefore, we aimed to assess this gap in our knowledge by studying patients with resectable gastric cancer.MethodsA multi‐institutional retrospective database comprising clinical information of 3575 patients who received resection of gastric cancer from 2010 to 2014 at nine institutions. Grades 2 or greater complications of the Clavien‐Dindo classification were judged as clinically relevant postoperative complications, and their associations with postoperative survival were assessed. We assessed the effect of complications on times of initiation and continuation of postoperative adjuvant chemotherapy by S‐1.ResultsA total of 2954 patients were included in the analysis. Clinically relevant postoperative complications occurred in 664 (23%) patients. Patients’ recurrence‐free survival rate incrementally decreased as the grade of complications became greater. Patients with abdominal complications (eg, leakage of pancreatic fluids, intra‐abdominal abscess, and anastomotic leakage) and those with nonabdominal complications (eg, pneumonia) experienced worse recurrence‐free survival compared to those without complications. Patients who had complications were generally at greater risk of disease recurrence, except for those who underwent laparoscopic surgery and those with pathological stage I. Delayed initiation and shorter continuation of adjuvant S‐1 chemotherapy was experienced by patients with postoperative complications.ConclusionsPostoperative complications adversely affected the prognosis in patients with resectable gastric cancer.
Highlights
Gastrectomy with systematic lymphadenectomy remains the backbone of curative treatment of patients who were present with resectable gastric cancer.[1,2] Despite the recent advances in imaging, surgical devices, and perioperative management, morbidity rate after gastrectomy is reportedly 20%‐30%.3,4 Incidence of postoperative complications invariably contributes to a longer hospitalization, increased medical costs, and diminished quality of life
A multicenter dataset consisting of a large contemporary patient cohort, amassed over 5 years, was analyzed to determine whether postoperative complications adversely affected the prognosis after radical gastrectomy.[16]
We found that the incidence of postoperative complications was associated with worsened prognoses regardless of the severity and types of complications, in part, attributed to the undesirable effect on tolerability to adjuvant treatment by S‐1
Summary
Gastrectomy with systematic lymphadenectomy remains the backbone of curative treatment of patients who were present with resectable gastric cancer.[1,2] Despite the recent advances in imaging, surgical devices, and perioperative management, morbidity rate after gastrectomy is reportedly 20%‐30%.3,4 Incidence of postoperative complications invariably contributes to a longer hospitalization, increased medical costs, and diminished quality of life. We analyzed a multicenter dataset, acquired within a 5‐year interval, to assess the prognostic significance of postoperative complications according to the type and severity in patients with resectable gastric cancer. A routine follow‐up after surgery consisted of laboratory tests including serum tumor markers every 3 months, contrasted CT scan every 6 months, and upper gastrointestinal endoscopy at 1, 3, and postoperative year in case patients have remnant stomach.[13] For patients who were pathologically diagnosed as stage II or III, postoperative adjuvant S‐1 monotherapy or capecitabine plus oxaliplatin was recommended if tolerated.[14] Treatment after recurrences was determined with consideration on the evidence available at the time of treatment and patient's condition. To evaluate the prognostic significance of postoperative complications, subgroup analyses were conducted according to the type of gastrectomy, surgical approach, disease stage, and postoperative treatment.
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