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. 2021 Oct 11:11:587309.
doi: 10.3389/fonc.2021.587309. eCollection 2021.

Impact of Type of Postoperative Complications on Long-Term Survival of Gastric Cancer Patients: Results From a High-Volume Institution in China

Hua-Yang Pang  1 , Lin-Yong Zhao  1 , Hui Wang  1 , Xiao-Long Chen  1 , Kai Liu  1 , Wei-Han Zhang  1 , Kun Yang  1 , Xin-Zu Chen  1 , Jian-Kun Hu  1
Affiliations

Impact of Type of Postoperative Complications on Long-Term Survival of Gastric Cancer Patients: Results From a High-Volume Institution in China

Hua-Yang Pang et al. Front Oncol. .

Abstract

Background: This study aimed to evaluate the impact of postoperative complication and its etiology on long-term survival for gastric cancer (GC) patients with curative resection.

Methods: From January 2009 to December 2014, a total of 1,667 GC patients who had undergone curative gastrectomy were analyzed. Patients with severe complications (SCs) (Clavien-Dindo grade III or higher complications or those causing a hospital stay of 15 days or longer) were separated into a "complication group." Univariate and multivariate analyses were performed to reveal the relationship between postoperative complications and long-term survival. A 2:1 propensity score matching (PSM) was used to balance baseline parameters between the two groups.

Results: SCs were diagnosed in 168 (10.08%) patients, including different etiology: infectious complications (ICs) in 111 (6.66%) and non-infectious complications (NICs) in 71 (4.26%) patients. Multivariate analysis showed that presence of SCs (P=0.001) was an independent prognostic factor for overall survival, and further analysis by complication type demonstrated that the deteriorated overall survival was mainly caused by ICs (P=0.004) rather than NICs (P=0.068). After PSM, patients with SCs (p=0.002) still had a significantly decreased overall survival, and the presence of ICs (P=0.002) rather than NICs (P=0.067) showed a negative impact on long-term survival.

Conclusion: Serious complications, particularly of an infectious type, may have a negative impact on overall survival of GC patients. However, additional multicenter prospective studies with larger sample size are required to verify this issue.

Keywords: gastric cancer; infectious complications; non-infectious complications; overall survival; severe complications.

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Conflict of interest statement

The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

Figures

Figure 1
Figure 1
The flow diagram of gastric cancer patients enrolled in this study.
Figure 2
Figure 2
Kaplan-Meier survival analysis of SC in entire cohort. (A) in all patients; (B) in Stage I, (C) in Stage II, and (D) in Stage III patients. The significance of the difference between survival curves was calculated by the log-rank test. SC, severe complication.
Figure 3
Figure 3
Kaplan-Meier survival analysis according to specific SC in entire cohort. (A) IC; (B) NIC. The significance of the difference between survival curves was calculated by the log-rank test. SC, severe complication; IC, infectious complication; NIC, non-infectious complication.
Figure 4
Figure 4
Kaplan-Meier survival analysis of SC in PSM cohort. (A) in all patients; (B) in Stage I, (C) in Stage II, and (D) in Stage III patients. The significance of the difference between survival curves was calculated by the log-rank test. SC, severe complication.
Figure 5
Figure 5
Kaplan-Meier survival analysis according to specific SC in PSM cohort. (A) ICs; (B) NICs. The significance of the difference between survival curves was calculated by the log-rank test. SC, severe complication; IC, infectious complication; NIC, non-infectious complication.
See this image and copyright information in PMC

References

    1. Smyth EC, Nilsson M, Grabsch HI, van Grieken NC, Lordick F. Gastric Cancer. Lancet (London England) (2020) 396(10251):635–48. doi: 10.1016/S0140-6736(20)31288-5 - DOI - PubMed
    1. Fontana E, Smyth EC, Cunningham D, Rao S, Watkins D, Allum WH, et al. Improved Survival in Resected Oesophageal and Gastric Adenocarcinomas Over a Decade: The Royal Marsden Experience 2001-2010. Gastric Cancer (2016) 19(4):1114–24. doi: 10.1007/s10120-015-0561-5 - DOI - PubMed
    1. Ghidini M, Donida BM, Totaro L, Ratti M, Pizzo C, Benzoni I, et al. Prognostic Factors Associated With Survival in a Large Cohort of Gastric Cancer Patients Resected Over a Decade at a Single Italian Center: The Cremona Experience. Clin Transl Oncol (2020) 22(7):1004–12. doi: 10.1007/s12094-019-02220-w - DOI - PubMed
    1. Zhang WH, Chen XZ, Liu K, Chen X-L, Yang K, Zhang B, et al. Outcomes of Surgical Treatment for Gastric Cancer Patients: 11-Year Experience of a Chinese High-Volume Hospital. Med Oncol (Northwood London England) (2014) 31(9):150. doi: 10.1007/s12032-014-0150-1 - DOI - PubMed
    1. Zhao Y, Yu P, Hao Y, Qian F, Tang Y, Shi B, et al. Comparison of Outcomes for Laparoscopically Assisted and Open Radical Distal Gastrectomy With Lymphadenectomy for Advanced Gastric Cancer. Surg Endosc (2011) 25(9):2960–6. doi: 10.1007/s00464-011-1652-y - DOI - PubMed