Abstract
Background
Postoperative intra-abdominal infection is known to adversely affect survival outcomes in patients with gastric cancer; however, previous reports have investigated this complication only in open surgery. This adverse effect is expected to be weakened by less invasive surgery, such as a laparoscopic approach, by way of maintaining immune function.
Methods
This study included 1223 patients with gastric cancer who underwent open (n = 439) or laparoscopic (n = 784) curative surgery between 2010 and 2015. For each approach, patients were divided into two groups based on presence or absence of postoperative intra-abdominal infection of Clavien–Dindo grade II or higher (C-group and NC-group, respectively). Survival outcomes were compared in propensity-matched cohorts to evaluate the impact of the complication.
Results
The incidences of Clavien–Dindo ≥ grade II postoperative intra-abdominal infectious complications were 9.7% (43/439) in open surgery and 9.8% (70/714) in laparoscopic surgery. After propensity score matching, 86 patients in open surgery and 138 in laparoscopic surgery were extracted for analysis. The 5-year overall survival rate in the open C-group (n = 43) was worse than that in the open NC-group (n = 43) but with no significant difference (70.9% vs. 82.8%, log-rank P = 0.18). The 5-year overall survival rates were equivalent between the laparoscopic C-group (n = 69) and the laparoscopic NC-group (n = 69) (90.5% vs. 90.4%, log-rank P = 0.99).
Conclusion
In general, postoperative intra-abdominal infection adversely affects survival outcomes; however, its impact may be weakened by less invasive surgery. Further evaluation using larger datasets is necessary before reaching definitive conclusions.
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We thank Hugh McGonigle, from Edanz (https://www.jp.edanz.com/ac), for editing a draft of the manuscript.
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Drs. Eigo Akimoto, Takahiro Kinoshita, Reo Sato, Masahiro Yura, Junichiro Harada, Mitsumasa Yoshida, Takafumi Okayama, Yuya Takabe, Yuya Tanaka, Yoshiaki Tomi, and Takumi Habu have no conflict of interest or financial ties to disclose.
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Akimoto, E., Kinoshita, T., Sato, R. et al. Impact of postoperative intra-abdominal infectious complications on survival outcomes in patients with gastric cancer who underwent laparoscopic surgery. Surg Endosc 37, 382–390 (2023). https://doi.org/10.1007/s00464-022-09522-1
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DOI: https://doi.org/10.1007/s00464-022-09522-1