Stomach cancer elective surgery morbidity and mortality at 90-Day (Hold Study): a prospective, international collaborative cohort study

Abstract

Background: Data on multinational 90-day mortality and morbidity rates after surgery for gastric cancer is limited in the literature. This study aimed to understand the 90-day mortality and morbidity outcomes among patients undergoing elective gastric cancer surgery, as in the GASTRODATA Registry, and to identify associated risk factors.

Methods: We conducted an international prospective study on patients aged ≥ 18 years undergoing elective surgery for gastric cancer with curative intent from January 4 to September 30, 2022. Known metastatic disease, concurrent secondary cancers, gastrointestinal stromal tumour (GIST) and Siewert type I/II oesophagogastric junction malignancies were excluded. Univariate and multivariate logistic regression were used to identify variables associated with the 90-day outcome.

Results: 380 collaborators from 47 countries submitted data on 1538 patients. Median age was 65 years (IQR: 19-94), and 58.5% were males. 90-day morbidity and mortality rates were 38.2% (n = 587) and 2.9% (n = 45), respectively. Pre-operative higher Charlson Comorbidity Index, higher ASA score, pre-operative weight loss > 10%, positive specimen margin, and post-operative pathological IV staging (p value < 0.05) were significantly associated with clinically relevant complications and mortality.

Conclusion: Elective gastric cancer surgery has a 90-day morbidity of 38.2% and a 90-day mortality of 2.9% globally. This study provided the most comprehensive international 90-day prospective data to date regarding gastric cancer surgery. Several factors associated with higher morbidity were identified, highlighting the importance of a unified language on surgical morbidity, prehabilitation, and ongoing audits to enhance patient outcomes.

Keywords: 90-Day postoperative outcomes; Anastomotic leaks; Elective surgery; Gastric cancer; Morbidity and mortality; Multinational audit; Patient safety; Surgical Complications.

Fig. 1

Heatmap Patients/Country: Number of patients (n = 1538) included in the HOLD Study by country (47 countries)

Chart 1

Forest plot representing the odds ratio of multivariate analysis of each specific variable's impact on the outcome (90-day morbidity and mortality, CD II-V). Error bars indicate the confidence intervals (CI). Ngg Total Total number of harvested Lymph Nodes. Ib-IIIc and IV reporting AJCC TNM Staging