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Meta-Analysis
. 2021 Jan-Dec:28:10732748211011955.
doi: 10.1177/10732748211011955.

Relationship Between Postoperative Complications and the Prognosis of Gastric Carcinoma Patients Who Underwent Surgical Resection: A Systematic Review and Meta-Analysis

Guofeng Chen  1 , Jun Wang  1   2 , Kaibo Chen  1 , Muxing Kang  1 , Hang Zhang  1 , Xiaoli Jin  1 , Lele Lin  2 , Jian Chen  1   2
Affiliations
Meta-Analysis

Relationship Between Postoperative Complications and the Prognosis of Gastric Carcinoma Patients Who Underwent Surgical Resection: A Systematic Review and Meta-Analysis

Guofeng Chen et al. Cancer Control. 2021 Jan-Dec.

Abstract

Background: Whether the presence of postoperative complications was associated with poor prognosis of gastric carcinoma (GC) patients remain controversial. This meta-analysis was designed and reported to compare the survival difference between patients with complications and non-complications.

Methods: Cochrane Library, PubMed and Embase databases were comprehensively searched for published literatures to review current evidence on this topic. The survival data were extracted, and a random-effect or fixed-effect model was used to analyze the correlation between postoperative complications and oncologic outcome of GC patients.

Results: Of all studies identified, 32 were eligible for this pooled analysis, with a total of 32,067 GC patients. The incidence of postoperative complications was approximately 12.5% to 51.0%. Among them, infectious complications varied from 3.0% to 28.6%, anastomotic leakage varied from 1.1% to 8.7% and postoperative pneumonia varied from 1.6% to 12.8%. The presence of postoperative complications resulted in a significant poorer overall survival (OS) of gastric carcinoma patients (hazard ratio [HR]:1.49, 95% confidence interval [CI]: 1.33-1.67, P < 0.001). Additionally, the pooled results showed a significant correlation between infectious complications and decreased OS (HR: 1.61, 95%CI: 1.38-1.88, P < 0.001). Concerning specific postoperative complications, we found that both anastomotic leakage (HR: 2.36, 95%CI: 1.62-3.42, P < 0.001) and postoperative pneumonia (HR: 1.74, 95%CI: 1.22-2.49, P = 0.002) impaired the OS of gastric carcinoma patients.

Conclusion: Postoperative complications were significantly correlated to recurrence and poor survival in gastric carcinoma patients. To gain a better surgical outcome and long-term oncological outcome, postoperative complications should be minimized as much as possible.

Keywords: anastomotic leakage; gastric carcinoma; postoperative complications; postoperative pneumonia; prognosis; survival.

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Conflict of interest statement

Declaration of Conflicting Interests: The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Figures

Figure 1.
Figure 1.
The flow diagram of study selection.
Figure 2.
Figure 2.
A, Forest plots evaluating the impact of postoperative complications on the OS of gastric carcinoma patients. B and C, Forest plots evaluating the impact of the severity of postoperative complications on the OS of gastric carcinoma patients. (B) For Clavien-Dindo grade ≥II; (C) for Clavien-Dindo grade ≥III.
Figure 3.
Figure 3.
Forest plots evaluating the impact of different types of postoperative complications on the OS of gastric carcinoma patients. (A) For infectious complications; (B) for intra-abdominal infectious complications; (C) for anastomotic leakage; (D) for postoperative pneumonia.
Figure 4.
Figure 4.
Funnel plot for the association between postoperative complications and the prognosis of gastric carcinoma patients. (A) For overall survival (OS); (B) for recurrence-free survival (RFS).
See this image and copyright information in PMC

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