TITLE:
Complications Following Surgery for Gastric Cancer: Analysis of Prospectively Collected Data
AUTHORS:
Lorenzo Bruno, Lucia Barni, Sabrina Pacciani, Gaia Masini, Lorenzo Tofani, Federica Tofani, Filippo Melli, Antonio Taddei, Manuela Andonova Miloeva, Luca Boni, Giancarlo Freschi, Paolo Bechi
KEYWORDS:
Gastric Cancer, Complications, Clavien-Dindo Classification, Survival Probability
JOURNAL NAME:
Journal of Cancer Therapy,
Vol.5 No.14,
December
25,
2014
ABSTRACT:
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.