Complications Following Surgery for Gastric Cancer: Analysis of Prospectively Collected Data

Abstract

Background and Aims: The complication rate after surgery for\rgastric cancer varies according to the particular definition of morbidity, so\rit’s necessary to report them using a standardized method, the Clavien-Dindo\rsystem. The purpose of this study was to prospectively analyze all post-gastrectomy complications in patients with gastric\radenocarcinoma according to the severity grade using Clavien-Dindo\rsystem, in order to identify risk factors for postoperative complications and their prognostic significance on survival. Methods: This study is based on data from 90\rconsecutive patients who underwent gastrectomy for\rgastric neoplasia between January 2010 and February 2014 at the same unit. 15\rpatients were excluded (benign tumors, GISTs, missing data). Complications were categorized according to the\rClavien-Dindo classification (uncomplicated patients vs patients classified ≥Grade\rI). The following risk factors were studied: age, BMI, sex, operation method, extent\rof resection, duration of surgery, transfusions, TNM staging, and lymph\rnode ratio. Multivariate logistic regression was used to evaluate the\rassociation between risk factors and presence of complications. To assess the\reffect on overall survival, after selection of covariates using backward elimination, the Cox proportional\rhazard model was applied. Results: Among these patients,\r49 (65.3%) developed complications, stratified as follows: Grade I, 6 (8%);\rGrade II, 24 (32%); Grade III, 6 (8%); Grade\rIV, 13 (17.3%). The laparoscopic technique (OR = 0.050; 95% CI = 0.005 - 0.550, p = 0.0143) and no transfusions (OR = 0.219; 95%\rCI = 0.058 - 0.827, p = 0.0251) were found to reduce the\rincidence of postoperative complications in the multivariate analysis. With regard\rto the survival analysis, lymph node ratio, malnutrition, extended resection\rand presence of complications were significant predictors of reduced survival\rin the multivariate analysis. Conclusions: Some variables can\rpredict the risk of postoperative complications, the occurrence of which is a\rpredictor of reduced probability of survival. In this respect it’s essential to\rreduce complications.