Abstract
Background: The aim of this study was to evaluate postoperative morbidity, mortality, and failure to rescue following complications after radical resection for gastric cancer. Methods: A retrospective analysis of the surgical database of patients with gastroesophageal malignancies at our institution was performed. All consecutive patients undergoing R0 gastrectomy for pT1–4 M0 gastric adenocarcinoma between October 1972 and February 2014 were eligible for this analysis. Patients were divided into two groups according to the date of surgery: an early cohort operated on from 1972–1992 and a late cohort operated on from 1993–2014. Both groups were compared regarding patient characteristics and surgical outcomes. Results: A total of 1107 patients were included. Postoperative mortality was more than twice as high in patients operated on from 1972–1992 compared to patients operated on from 1993–2014 (6.8% vs. 3.2%, p = 0.017). Between both groups, no significant difference in failure to rescue after major surgical complications was observed (20.8% vs. 20.5%, p = 1.000). Failure to rescue after other surgical and non-surgical complications was 37.8% in the early cohort compared to 3.2% in the late cohort (p < 0.001). Non-surgical complications accounted for 71.2% of lethal complications between 1972 and 1992, but only for 18.2% of lethal complications between 1993 and 2014 (p = 0.002). Conclusion: In the course of four decades, postoperative mortality after radical resection for gastric cancer has more than halved. In this cohort, the reason for this decrease was reduced mortality due to non-surgical complications. Major surgical morbidity after gastrectomy remains challenging.
Highlights
Resection for gastric cancer is regarded as a high-risk surgery with significant morbidity and mortality [1,2]
The results showed that postoperative complications are a significant risk factor for poor overall survival, an effect which was mainly caused by complication-associated early mortality [9]
This study presents one of the rare reports on the results of surgery for gastric cancer in a large cohort of 1107 consecutive patients (1972 to 1992: n = 761 and 1993 to 2014: n = 346), over a time period of more than four decades at a European university hospital
Summary
Resection for gastric cancer is regarded as a high-risk surgery with significant morbidity and mortality [1,2]. The focus of large-scale multicenter studies has been to examine variations in surgical outcomes among patients undergoing surgery for gastric cancer between different institutions [4,5]. Patients were divided into two groups according to the date of surgery: an early cohort operated on from 1972–1992 and a late cohort operated on from 1993–2014 Both groups were compared regarding patient characteristics and surgical outcomes. Postoperative mortality was more than twice as high in patients operated on from 1972–1992 compared to patients operated on from 1993–2014 (6.8% vs 3.2%, p = 0.017) Between both groups, no significant difference in failure to rescue after major surgical complications was observed (20.8% vs 20.5%, p = 1.000)
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