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Late complication after gastrectomy for clinical stage I cancer: supplementary analysis of JCOG0912

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Abstract

Background

Late complications following gastric cancer surgery, including postgastrectomy syndromes, are complex problems requiring a solution. Reported risk factors for developing late complications include surgery-related factors, such as the surgical approach and the extent of resection and reconstruction. However, this has not been assessed in a prospective study with a large sample size. Therefore, this study aimed to evaluate associations between surgery-related factors and the development of late complications. Data from the JCOG0912 trial were used. It compared laparoscopy-assisted distal gastrectomy (LADG) to open distal gastrectomy (ODG) in clinical stage I gastric cancer patients.

Methods

This study included 881/921 patients enrolled in the JCOG0912 trial. The incidence of late complications was compared between the ODG and the LADG arms. In addition, associations between surgery-related factors and the development of late complications were assessed by multivariable analyses using the proportional odds model to identify relevant risk factors.

Results

There was no difference in the type or number of patients with late complications between the LADG and the ODG arms. The multivariable analysis for each late complication revealed that the Billroth-I reconstruction (vs. R-en-Y or Billroth-II) had a lower risk of cholecystitis [odds ratio (OR) 0.187, 95% confidence interval (CI) 0.039–0.905, P = 0.037] or ileus (OR 0.116, 95%CI 0.033–0.406, P < 0.001), and pylorus-preserving gastrectomy (vs. R-en-Y or Billroth-II) had a higher risk of reflux esophagitis (OR 3.348, 95% CI 1.371–8.176, P = 0.008). The surgical approach was not a risk factor for any late complications.

Conclusion

Differences in surgical approaches did not constitute a risk for developing late complications after gastrectomy. Billroth-I reconstruction reduced the risk of ileus and cholecystitis, but pylorus-preserving gastrectomy carried a risk for reflux esophagitis.

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Funding

The study was supported in part by National Cancer Center Research and Development Funds (26-A-4, 29-A-3, 2020-J-3) and the Japan Agency for Medical Research and Development (Grant Number JP18ck0106317).

Author information

Authors and Affiliations

  1. Division of Gastric Surgery, Shizuoka Cancer Center, 1007 Shimonagakubo, Nagaizumi-cho, Sunto-gun, Shizuoka, 411-8777, Japan

    Makoto Hikage & Masanori Terashima

  2. Department of Gastroenterological Surgery, National Hospital Organization Shikoku Cancer Center, Matsuyama, Japan

    Shinji Hato

  3. JCOG Data Center/Operations Office, National Cancer Center Hospital, Tokyo, Japan

    Kohei Uemura

  4. Gastric Surgery Division, National Cancer Center Hospital East, Chiba, Japan

    Masahiro Yura

  5. Department of Gastrointestinal Surgery, Tokyo Medical and Dental University, Tokyo, Japan

    Yuya Sato

  6. Department of Surgery, Tochigi Cancer Center Hospital, Tochigi, Japan

    Hisayuki Matsushita

  7. Department of Surgery, Tokyo Metropolitan Cancer and Infectious Diseases Center Komagome Hospital, Tokyo, Japan

    Haruhiko Cho

  8. Department of Upper Gastrointestinal Surgery, Kitasato University School of Medicine, Kanagawa, Japan

    Naoki Hiki

  9. Department of Surgery, Gastroenterological Center, Yokohama City University, Kanagawa, Japan

    Chikara Kunisaki

  10. Department of Surgery, Kansai Medical University, Osaka, Japan

    Kentaro Inoue

  11. Department of Surgery, Hiroshima City Hiroshima Citizens Hospital, Hiroshima, Japan

    Yasuhiro Choda

  12. Department of Oncology and General Medicine, IMSUT Hospital, The Institute of Medical Science, The University of Tokyo, Tokyo, Japan

    Narikazu Boku

  13. Department of Gastric Surgery, National Cancer Center Hospital, Tokyo, Japan

    Takaki Yoshikawa

  14. Department of Gastroenterological Surgery, Tachikawa Hospital, Tokyo, Japan

    Hitoshi Katai

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  1. Makoto Hikage
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  2. Shinji Hato
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Correspondence to Masanori Terashima.

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Disclosures

Dr. Haruhiko Cho received personal fees from Ethicon, outside the submitted work. Dr. Naoki Hiki received grants and personal fees from Abbott Japan, EA, Johnson and Johnson, Otsuka, Kaken, Covidien Japan, Takeda, Daiichi Sankyo, Taiho, Tsumura, Terumo, MIYARISAN, grants from Shionogi, Chugai, HOGY medical, Yakult, personal fees from NHK, Pfizer, AstraZeneca, Nihon Pharma., Olympus, Novartis, Intuitive Surgical Japan, Ono, Kaigen, QLife, Sumitomo Dainippon, Nestlé Japan, outside the submitted work. Dr. Yasuhiro Choda received personal fees from Ono, Bristol-Myers Squibb, outside the submitted work. Dr. Narikazu Boku received personal fees from Taiho, Ono, Bristol-Myers Squibb, Daiichi Sankyo, outside the submitted work. Dr. Masanori Terashima received personal fees from Taiho, Chugai, Ono, Bristol-Myers Squibb, Yakult, Takeda, Eli Lilly, Pfizer, Daiichi Sankyo, Johnson and Johnson, Medtronic Japan, Intuitive Surgical Japan, Olympus, outside the submitted work. Drs. Makoto Hikage, Shinji Hato, Kohei Uemura, Masahiro Yura, Yuya Sato, Hisayuki Matsushita, Chikara Kunisaki, Kentaro Inoue, Takaki Yoshikawa, and Hitoshi Katai have no conflicts of interest or financial ties to disclose.

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Hikage, M., Hato, S., Uemura, K. et al. Late complication after gastrectomy for clinical stage I cancer: supplementary analysis of JCOG0912. Surg Endosc 37, 2958–2968 (2023). https://doi.org/10.1007/s00464-022-09804-8

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