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Prognostic Significance of Complications after Curative Surgery for Gastric Cancer

  • Gastrointestinal Oncology
  • Published:
Annals of Surgical Oncology Aims and scope Submit manuscript

Abstract

Background

Postoperative complications such as anastomotic leakage were reported to be a major independent prognostic factor for long-term survival in gastrointestinal malignancies. This study sought to clarify the prognostic significance of postoperative inflammatory complications specifically for patients with gastric cancer.

Methods

This study included 1,395 patients who underwent curative resection for gastric cancer from 2005 to 2008. Complications were evaluated according to the Clavien-Dindo classification. Overall survival (OS) and disease-specific mortality (DSM) were compared between complication and no-complication groups. Presence of complications was modeled by the Cox proportional hazard model for OS and the Fine and Gray competing risk regression model for DSM to assess the correlation between complication and prognosis.

Results

The median follow-up time was 3.1 years. Two hundred seven patients (14.8 %) had complications of grade 2 or higher. Of 131 patients who died within this period, 87 died of gastric cancer. The 3-year OS in the complication group was 84.1 % compared to 93.1 % in the no-complication group (P < 0.0001). The cumulative incidence of DSM was also significantly worse in patients with complications (P < 0.0001). Multivariate analysis identified the same significant increasing risk of complication for both OS (hazard ratio 1.88; 95 % confidence interval 1.26–2.80) and DSM (hazard ratio 1.90; 95 % confidence interval 1.19–3.02).

Conclusions

Postoperative complications that can cause prolonged inflammation have an obvious impact not only on the OS but also on the DSM of patients with gastric cancer even if the tumor is resected curatively.

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References

  1. Rivera F, Vega-Villegas ME, López-Brea MF. Chemotherapy of advanced gastric cancer. Cancer Treat Rev. 2007;33:315–24.

    Article  CAS  PubMed  Google Scholar 

  2. Maehara Y, Hasuda S, Koga T, et al. Postoperative outcome and sites of recurrence in patients following curative resection of gastric cancer. Br J Surg. 2000;87:353–7.

    Article  CAS  PubMed  Google Scholar 

  3. Adachi Y, Oshiro T, Mori M, et al. Prediction of early and late recurrence after curative resection for gastric carcinoma. Cancer. 1996;77:2445–8.

    Article  CAS  PubMed  Google Scholar 

  4. Roukos DH, Kappas AM. Limitations in controlling risk for recurrence after curative surgery for advanced gastric cancer are now well-explained by molecular-based mechanisms. Ann Surg Oncol. 2001;8:620–1.

    Article  CAS  PubMed  Google Scholar 

  5. Isobe Y, Nashimoto A, Akazawa K, et al. Gastric cancer treatment in Japan: 2008 annual report of the JGCA nationwide registry. Gastric Cancer. 2011;14:301–16.

    Article  PubMed Central  PubMed  Google Scholar 

  6. Walker KG, Bell SW, Rickard MJ, et al. Anastomotic leakage is predictive of diminished survival after potentially curative resection for colorectal cancer. Ann Surg. 2004;240:255–9.

    Article  PubMed  Google Scholar 

  7. McArdle CS, McMillan DC, Hole DJ. Impact of anastomotic leakage on long-term survival of patients undergoing curative resection for colorectal cancer. Br J Surg. 2005;92:1150–4.

    Article  CAS  PubMed  Google Scholar 

  8. Lerut T, Moons J, Coosemans W, et al. Postoperative complications after transthoracic esophagectomy for cancer of the esophagus and gastroesophageal junction are correlated with early cancer recurrence: role of systematic grading of complications using the modified Clavien classification. Ann Surg. 2009;250:798–807.

    Article  PubMed  Google Scholar 

  9. Rizk NP, Bach PB, Schrag D, et al. The impact of complications on outcomes after resection for esophageal and gastroesophageal junction carcinoma. J Am Coll Surg. 2004;198:42–50.

    Article  PubMed  Google Scholar 

  10. Sierzega M, Kolodziejczyk P; Kulig J. Polish Gastric Cancer Study Group. Impact of anastomotic leakage on long-term survival after total gastrectomy for carcinoma of the stomach. Br J Surg. 2010;97:1035–42.

    Article  CAS  PubMed  Google Scholar 

  11. Yoo HM, Lee HH, Shim JH, et al. Negative impact of leakage on survival of patients undergoing curative resection for advanced gastric cancer. J Surg Oncol. 2011;104:734–40.

    Article  PubMed  Google Scholar 

  12. Sobin LH, Gospodarowicz MK, Wittekind C. TNM classification of malignant tumours. 7th edition. New York: Wiley-Blackwell; 2010.

    Google Scholar 

  13. Dindo D, Demartines N, Clavien PA. Classification of surgical complications: a new proposal with evaluation in a cohort of 6336 patients and results of a survey. Ann Surg. 2004;240:205–13.

    Article  PubMed  Google Scholar 

  14. Clavien PA, Barkun J, de Oliveira ML, et al. The Clavien-Dindo classification of surgical complications: five-year experience. Ann Surg. 2009;250:187–96.

    Article  PubMed  Google Scholar 

  15. Kaplan EL, Meier P. Nonparametric estimation from incomplete observations. J Am Stat Assoc. 1958;53:457–81.

    Article  Google Scholar 

  16. Fine JP, Gray RJ. A proportional hazards model for the subdistribution of a competing risk. J Am Stat Assoc. 1999;94:496–509.

    Article  Google Scholar 

  17. Kalbfleisch JD, Prentice RL. The statistical analysis of failure time data. New York: Wiley; 1980.

    Google Scholar 

  18. Roder JD, Böttcher K, Siewert JR, et al. Prognostic factors in gastric carcinoma. Results of the German Gastric Carcinoma Study, 1992. Cancer. 1993;72:2089–97.

    Article  CAS  PubMed  Google Scholar 

  19. Siewert JR, Böttcher K, Stein HJ, et al. Relevant prognostic factors in gastric cancer: ten-year results of the German Gastric Cancer Study. Ann Surg. 1998;228:449–61.

    Article  CAS  PubMed  Google Scholar 

  20. Kodera Y, Sasako M, Yamamoto S, et al; Gastric Cancer Surgery Study Group of Japan Clinical Oncology Group. Identification of risk factors for the development of complications following extended and superextended lymphadenectomies for gastric cancer. Br J Surg. 2005;92:1103–9.

    Article  CAS  PubMed  Google Scholar 

  21. Hosono S, Arimoto Y, Ohtani H, et al. Meta-analysis of short term outcomes after laparoscopic-assisted distal gastrectomy. World J Gastroenterol. 2006;12:7676–83.

    PubMed  Google Scholar 

  22. Lee JH, Han HS, Lee JH. A prospective randomized study comparing open vs laparoscopy-assisted distal gastrectomy in early gastric cancer: early results. Surg Endosc. 2005;19:168–73.

    Article  PubMed  Google Scholar 

  23. Adachi Y, Shiraishi N, Shiromizu A, et al. Laparoscopy-assisted Billroth I gastrectomy compared with conventional open gastrectomy. Arch Surg. 2000;135:806–10.

    Article  CAS  PubMed  Google Scholar 

  24. Kitano S, Shiraishi N, Fujii K, et al. A randomized controlled trial comparing open vs laparoscopyassisted distal gastrectomy for the treatment of early gastric cancer: an interim report. Surgery. 2002;131:306–11.

    Article  Google Scholar 

  25. Mochiki E, Nakabayashi T, Kamimura H, et al. Gastrointestinal recovery and outcome after laparoscopy-assisted versus conventional open distal gastrectomy for early gastric cancer. World J Surg. 2002;26:1145–9.

    Article  PubMed  Google Scholar 

  26. Hartgrink HH, van de Velde CJ, Putter H, et al. Extended lymph node dissection for gastric cancer: who may benefit? Final results of the randomized Dutch gastric cancer group trial. J Clin Oncol. 2004;22:2069–77.

    Article  CAS  PubMed  Google Scholar 

  27. Danielson H, Kokkola A, Kiviluoto T, et al. Clinical outcome after D1 vs D2–3 gastrectomy for treatment of gastric cancer. Scand J Surg. 2007;96:35–40.

    CAS  PubMed  Google Scholar 

  28. Memon MA, Subramanya MS, Khan S, et al. Meta-analysis of D1 versus D2 gastrectomy for gastric adenocarcinoma. Ann Surg. 2011;253:900–11.

    Article  PubMed  Google Scholar 

  29. Songun I, Putter H, Kranenbarg EM, et al. Surgical treatment of gastric cancer: 15-year follow-up results of the randomised nationwide Dutch D1D2 trial. Lancet Oncol. 2010;11:439–49.

    Article  PubMed  Google Scholar 

  30. Mimori K, Fukagawa T, Kosaka Y, et al. Hematogenous metastasis in gastric cancer requires isolated tumor cells and expression of vascular endothelial growth factor receptor-1. Clin Cancer Res. 2008;14:2609–16.

    Article  CAS  PubMed  Google Scholar 

  31. Arigami T, Uenosono Y, Hirata M, et al. B7-H3 expression in gastric cancer: a novel molecular blood marker for detecting circulating tumor cells. Cancer Sci. 2011;102:1019–24.

    Article  CAS  PubMed  Google Scholar 

  32. Mantovani A, Allavena P, Sica A, et al. Cancer-related inflammation. Nature. 2008;454:436–44.

    Article  CAS  PubMed  Google Scholar 

  33. McMillan DC. Systemic inflammation, nutritional status and survival in patients with cancer. Curr Opin Clin Nutr Metab Care. 2009;12:223–6.

    Article  PubMed  Google Scholar 

  34. Japanese Gastric Cancer Association. Japanese classification of gastric carcinoma. 2nd English edition. Gastric Cancer. 1998;1:10–24.

    Article  PubMed  Google Scholar 

  35. Sakuramoto S, Sasako M, Yamaguchi T, et al. ACTS-GC Group. Adjuvant chemotherapy for gastric cancer with S-1, an oral fluoropyrimidine. N Engl J Med. 2007;357:1810–20.

    Article  CAS  PubMed  Google Scholar 

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Disclosure

The authors declare no conflict of interest.

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Authors and Affiliations

  1. Department of Gastroenterological Surgery, Cancer Institute Hospital, Japanese Foundation for Cancer Research, Koto-ku, Tokyo, Japan

    Takeshi Kubota MD, PhD, Naoki Hiki MD, PhD, Takeshi Sano MD, PhD, Souya Nunobe MD, PhD, Koshi Kumagai MD, PhD, Susumu Aikou MD, PhD, Ryohei Watanabe MD, PhD, Toshiyuki Kosuga MD, PhD & Toshiharu Yamaguchi MD, PhD

  2. Department of Biostatistic, National Cancer Center, Kashiwa, Chiba, Japan

    Shogo Nomura MSc

Authors
  1. Takeshi Kubota MD, PhD
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  2. Naoki Hiki MD, PhD
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  3. Takeshi Sano MD, PhD
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  4. Shogo Nomura MSc
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  5. Souya Nunobe MD, PhD
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  6. Koshi Kumagai MD, PhD
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  7. Susumu Aikou MD, PhD
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  8. Ryohei Watanabe MD, PhD
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  9. Toshiyuki Kosuga MD, PhD
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  10. Toshiharu Yamaguchi MD, PhD
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Correspondence to Naoki Hiki MD, PhD.

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Kubota, T., Hiki, N., Sano, T. et al. Prognostic Significance of Complications after Curative Surgery for Gastric Cancer. Ann Surg Oncol 21, 891–898 (2014). https://doi.org/10.1245/s10434-013-3384-9

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  • DOI: https://doi.org/10.1245/s10434-013-3384-9

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