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

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Background and Aims: The complication rate after surgery for gastric cancer varies according to the particular definition of morbidity, so it’s necessary to report them using a standardized method, the Clavien-Dindo system. The purpose of this study was to prospectively analyze all post-gastrectomy complications in patients with gastric adenocarcinoma according to the severity grade using Clavien-Dindo system, in order to identify risk factors for postoperative complications and their prognostic significance on survival. Methods: This study is based on data from 90 consecutive patients who underwent gastrectomy for gastric neoplasia between January 2010 and February 2014 at the same unit. 15 patients were excluded (benign tumors, GISTs, missing data). Complications were categorized according to the Clavien-Dindo classification (uncomplicated patients vs patients classified ≥Grade I). The following risk factors were studied: age, BMI, sex, operation method, extent of resection, duration of surgery, transfusions, TNM staging, and lymph node ratio. Multivariate logistic regression was used to evaluate the association between risk factors and presence of complications. To assess the effect on overall survival, after selection of covariates using backward elimination, the Cox proportional hazard model was applied. Results: Among these patients, 49 (65.3%) developed complications, stratified as follows: Grade I, 6 (8%); Grade II, 24 (32%); Grade III, 6 (8%); Grade IV, 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% CI = 0.058 - 0.827, p = 0.0251) were found to reduce the incidence of postoperative complications in the multivariate analysis. With regard to the survival analysis, lymph node ratio, malnutrition, extended resection and presence of complications were significant predictors of reduced survival in the multivariate analysis. Conclusions: Some variables can predict the risk of postoperative complications, the occurrence of which is a predictor of reduced probability of survival. In this respect it’s essential to reduce complications.
Cite this paper
Bruno, L. , Barni, L. , Pacciani, S. , Masini, G. , Tofani, L. , Tofani, F. , Melli, F. , Taddei, A. , Miloeva, M. , Boni, L. , Freschi, G. and Bechi, P. (2014) Complications Following Surgery for Gastric Cancer: Analysis of Prospectively Collected Data. Journal of Cancer Therapy, 5, 1454-1466. doi: 10.4236/jct.2014.514147. 
 

[1] Kubota, T., Hiki, N., Sano, T., Nomura, S., et al. (2014) Prognostic Significance of Complications after Curative Surgery for Gastric Cancer. Annals of Surgical Oncology, 21, 891-898.
http://dx.doi.org/10.1245/s10434-013-3384-9
[2] Lee, K.G., Lee, H.J., Yang, J.Y., et al. (2014) Risk Factors Associated with Complication Following Gastrectomy for Gastric Cancer: Retrospective Analysis of Prospectively Collected Data Based on the Clavien-Dindo System. Journal of Gastrointestinal Surgery, 18, 1269-1277.
http://dx.doi.org/10.1007/s11605-014-2525-1
[3] Dindo, D., Demartines, N. and Clavien, P.A. (2004) Classification of Surgical Complications: A New Proposal with Evaluation in a Cohort of 6336 Patients and Results of a Survey. Annals of Surgery, 240, 205-213. http://dx.doi.org/10.1097/01.sla.0000133083.54934.ae
[4] Lee, J.H., Park, D.J., Kim, H.H., Lee, H.J. and Yang, H.K. (2012) Comparison of Complications after Laparoscopy-Assisted Distal Gastrectomy and Open Distal Gastrectomy for Gastric Cancer Using the Clavien-Dindo Classification. Surgical Endoscopy, 26, 1287-1295. http://dx.doi.org/10.1007/s00464-011-2027-0
[5] Jiang, N., Deng, J.Y., Ding, X.W., Zhang, L., Liu, H.G., Liang, Y.X. and Liang, H. (2014) Effect of Complication Grade on Survival Following Curative Gastrectomy for Carcinoma. World Journal of Gastroenterology, 20, 8244-8252. http://dx.doi.org/10.3748/wjg.v20.i25.8244
[6] Novara, G., Ficarra, V., D’Elia, C., Secco, S., Cavalleri, S. and Artibani, W. (2010) Prospective Evaluation with Standardised Criteria for Postoperative Complications after Robotic-Assisted Laparoscopic Radical Prostatectomy. European Urology, 57, 363-370. http://dx.doi.org/10.1016/j.eururo.2009.11.032
[7] Wechter, M.E., Mohd, J., Magrina, J.F., Cornella, J.L., Magtibay, P.M., Wilson, J.R. and Kho, R.M. (2014) Complications in Robotic-Assisted Gynecologic Surgery According to Case Type. A Six-Year Retrospective Cohort Study Using Clavien-Dindo Classification. Journal of Minimally Invasive Gynecology, 21, 844-850. http://dx.doi.org/10.1016/j.jmig.2014.03.016
[8] Sink, E.L., Leunig, M., Zaltz, I., Gilbert, J.C. and Clohisy, J. (2012) Reliability of a Complication Classification System for Orthopedic Surgery. Clinical Orthopaedics and Related Research, 470, 2220-2226.
http://dx.doi.org/10.1007/s11999-012-2343-2
[9] Orsenigo, E., Bissolati, M., Socci, C., Chiari, D., Muffatti, F., Nifosi, J. and Staudacher, C. (2014) Duodenal Stump Fistula after Gastric Surgery for Malignancies: A Retrospective Analysis of Risk Factors in a Single Centre Experience. Gastric Cancer, 17, 733-744. http://dx.doi.org/10.1007/s10120-013-0327-x
[10] de Manzoni, G., Roviello, F. and Squini, W. (2012) Surgery in the Multimodal Management of Gastric Cancer, Foreword by Keiichi Maruyama GIRCG. Springer-Verlag, Italia.
[11] http://www.iss.it/lgac/docu/cont.php?id=278&lang=1&tipo=%2032
[12] Bickendach, K. and Strong, V.E. (2012) Comparisons of Gastric Cancer Treatments: East vs. West. Journal of Gastric Cancer, 12, 55-62. http://dx.doi.org/10.5230/jgc.2012.12.2.55
[13] Li, Q.G., Li, P., Tang, D., Chen, J. and Wang, D.R. (2013) Impact of Postoperative Complications on Long-Term Survival after Radical Resection for Gastric Cancer. World Journal of Gastroenterology, 19, 4060-4065. http://dx.doi.org/10.3748/wjg.v19.i25.4060
[14] Hayashi, T., Yoshikawa, T., Aoyama, T., Ogata, T., Cho, H. and Tsuburaya, A. (2012) Severity of Complications after Gastrectomy in Elderly Patients with Gastric Cancer. World Journal of Surgery, 36, 2139-2145. http://dx.doi.org/10.1007/s00268-012-1653-6
[15] Pata, G., Solaini, L., Roncali, S., Pasini, M. and Ragni, F. (2013) Impact of Obesity on Early Surgical and Oncologic Outcomes after Total Gastrectomy with “Over-D1” Lymphadenectomy for Gastric Cancer. World Journal of Surgery, 37, 1072-1081. http://dx.doi.org/10.1007/s00268-013-1942-8
[16] Fraczek, M., Jeziorski, A., Krawczyk, M., Starzynska, T. and Wallner, G. (2010) Implications of Overweight in Gastric Cancer: A Multicenter Study in a Western Patient Population. European Journal of Surgical Oncology, 36, 969-976. http://dx.doi.org/10.1016/j.ejso.2010.07.007
[17] Eom, B.W., Joo, J., Yoon, H.M., Ryu, K.W., Kim, Y.W. and Lee, J.H. (2014) A Body Shape Index Has a Good Correlation with Postoperative Complications in Gastric Cancer Surgery. Annals of Surgical Oncology, 21, 1115-1122. http://dx.doi.org/10.1245/s10434-013-3409-4
[18] Krakauer, N.Y. and Krakauer, J.C. (2012) A New Body Shape Index Predicts Mortality Hazard Independently of Body Mass Index. PLoS ONE, 7, e39504.
http://dx.doi.org/10.1371/journal.pone.0039504
[19] Wu, M.H., Lin, M.T. and Chen, W.J. (2008) Effect of Perioperative Parenteral Nutritional Support for Gastric Cancer Patients Undergoing Gastrectomy. Hepatogastroenterology, 55, 799-802.
[20] Kong, F., Li, H., Fan, Y., Zhang, X.W., Cao, S., Yu, J.P., et al. (2013) Overweight Patients Achieve Ideal Body Weight Following Curative Gastrectomy Resulting in Better Long-Term Prognosis. Obesity Surgery, 23, 650-656. http://dx.doi.org/10.1007/s11695-012-0847-1
[21] Kiyama, T., Mizutani, T., Okuda, T., Fujita, I., Tokunaga, A., Tajiri, T., Barbul, A., et al. (2005) Postoperative Changes in Body Composition after Gastrectomy. Journal of Gastrointestinal Surgery, 9, 313-319. http://dx.doi.org/10.1016/j.gassur.2004.11.008
[22] Sah, B.K., Zhu, Z.G., Chen, M.M., Xiang, M., Chen, J., Yan, M. and Lin, Y.Z. (2009) Effect of Surgical Work Volume on Postoperative Complication: Superiority of Specialized Center in Gastric Cancer Treatment. Langenbeck’s Archives of Surgery, 394, 41-47. http://dx.doi.org/10.1007/s00423-008-0358-7
[23] Liang, Y.X., Guo, H.H., Deng, J.Y., Wang, B.G., Ding, X.W., Wang, X.N., et al. (2013) Impact of Intraoperative Blood Loss on Survival after Curative Resection for Gastric Cancer. World Journal of Gastroenterology, 19, 5542-5550. http://dx.doi.org/10.3748/wjg.v19.i33.5542
[24] Sutton, J.M., Kooby, D.A., Wilson, G.C., Squires III, M.H., Hanseman, D.J., Maithel, S.K., et al. (2014) Perioperative Blood Transfusion Is Associated with Decreased Survival in Patients Undergoing Pancreaticoduodenectomy for Pancreatic Adenocarcinoma: A Multi-Institutional Study. Journal of Gastrointestinal Surgery, 18, 1575-1587.
[25] Waters, J.H., Yazer, M., Chen, Y.F. and Kloke, J. (2012) Blood Salvage and Cancer Surgery: A Meta-Analysis of Available Studies. Transfusion, 52, 2167-2173.
http://dx.doi.org/10.1111/j.1537-2995.2011.03555.x
[26] Adamina, M., Gié, O., Demartines, N. and Ris, F. (2013) Contemporary Perioperative Care Strategies. British Journal of Surgery, 100, 38-54. http://dx.doi.org/10.1002/bjs.8990
[27] Li, H.T., Han, X.P., Su, L., Zhu, W.-K., Xu, W., Li, K., et al. (2014) Short-Term Efficacy of Laparoscopy-Assisted vs. Open Radical Gastrectomy in Gastric Cancer World. Journal of Gastrointestinal Surgery, 6, 59-64.
[28] Cheng, Q., Pang, T.C.Y., Hollands, M.J., Richardson, A.J., Pleass, H., Johnston, E.S. and Lam, V.W.T. (2014) Systematic Review and Meta-Analysis of Laparoscopic versus Open Distal Gastrectomy. Journal of Gastrointestinal Surgery, 18, 1087-1099. http://dx.doi.org/10.1007/s11605-014-2519-z
[29] Aoyama, T., Yoshikawa, T., Hayashi, T., Hasegawa, S., Tsuchida, K., Yamada, T., et al. (2014) Randomized Comparison of Surgical Stress and the Nutritional Status between Laparoscopy-Assisted and Open Distal Gastrectomy for Gastric Cancer. Annals of Surgical Oncology, 21, 1983-1990.
http://dx.doi.org/10.1245/s10434-014-3509-9
[30] Huscher, C.G., Mingoli, A., Sgarzini, G., Sansonetti, A., Di Paola, M., Recher, A. and Ponzano, C. (2005) Laparoscopic versus Open Subtotal Gastrectomy for Distal Gastric Cancer: Five-Year Results of a Randomized Prospective Trial. Annals of Surgery, 241, 232-237.
http://dx.doi.org/10.1097/01.sla.0000151892.35922.f2
[31] Adachi, Y., Shiraishi, N., Shiromizu, A., Bandoh, T., Aramaki, M. and Kitano, S. (2000) Laparoscopy-Assisted Billroth I Gastrectomy Compared with Conventional Open Gastrectomy. Annals of Surgery, 135, 806-810. http://dx.doi.org/10.1001/archsurg.135.7.806
[32] Kim, H.H., Hyung, W.J., Cho, G.S., Kim, M.C., Han, S.-U., Kim, W., et al. (2010) Morbidity and Mortality of Laparoscopic Gastrectomy versus Open Gastrectomy for Gastric Cancer: An Interim Report—A Phase III Multicenter, Prospective, Randomized Trial (KLASS Trial). Annals of Surgery, 251, 417-420.
http://dx.doi.org/10.1097/SLA.0b013e3181cc8f6b
[33] Kim, K.M., An, J.Y., Kim, H.I., Cheong, J.H., Hyung, W.J. and Noh, S.H. (2012) Major Early Complications Following Open, Laparoscopic and Gastrectomy. British Journal of Surgery, 99, 1681-1687.
http://dx.doi.org/10.1002/bjs.8924
[34] Hyun, M.H., Lee, C.H., Kim, H.J., Ton, Y. and Park, S.S. (2013) Systematic Review and Meta-Analysis of Robotic Surgery Compared with Conventional Laparoscopic and Open Resections for Gastric Carcinoma. British Journal of Surgery, 100, 1566-1578.
[35] Suda, K., Man-I, M., Ishida, Y., Kawamura, Y., Satoh, S. and Uyama, I. (2014) Potential Advantages of Robotic Radical Gastrectomy for Gastric Adenocarcinoma in Comparison with Conventional Laparoscopic Approach: A Single Institutional Retrospective Comparative Cohort Study. Surgical Endoscopy.
[36] Katz, S.C., Shia, J., Liau, K.H., Gonen, M., Ruo, L., Jarnagin, W.R., Fong, Y., et al. (2009) Operative Blood Loss Independently Predicts Recurrence and Survival after Resection of Hepatocellular Carcinoma. Annals of Surgery, 249, 617-623. http://dx.doi.org/10.1097/SLA.0b013e31819ed22f
[37] Balkwill, F. and Mantovani, A. (2001) Inflammation and Cancer: Back to Virchow? The Lancet, 357, 539-545. http://dx.doi.org/10.1016/S0140-6736(00)04046-0
[38] Mynster, T., Christensen, I.J., Moesgaard, F. and Nielsen, H.J. (2000) Effect of the Combination of Blood Transfusion and Postoperative Infectious Complications on Prognosis after Surgery for Colorectal Cancer. British Journal of Surgery, 87, 1553-1562. http://dx.doi.org/10.1046/j.1365-2168.2000.01570.x
[39] Nash, G.F., Chopada, A., Patel, H. and Kakkar, A.K. (2002) Stored Blood Products Stimulate Cancer Growth. British Journal of Surgery, 89, 19. http://dx.doi.org/10.1046/j.1365-2168.89.s.1.9_10.x
[40] GIRCG (2013) Tailored and Multidisciplinary Gastric Cancer Treatment. Proceedings of the 10th International Gastric Cancer Congress, Verona, 19-22 June 2013.                                          eww141226lx
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