Annals of Surgical Oncology

, Volume 21, Issue 3, pp 891–898 | Cite as

Prognostic Significance of Complications after Curative Surgery for Gastric Cancer

  • Takeshi Kubota
  • Naoki Hiki
  • Takeshi Sano
  • Shogo Nomura
  • Souya Nunobe
  • Koshi Kumagai
  • Susumu Aikou
  • Ryohei Watanabe
  • Toshiyuki Kosuga
  • Toshiharu Yamaguchi
Gastrointestinal Oncology



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.


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.


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).


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.


Gastric Cancer Overall Survival Anastomotic Leakage Laparoscopic Gastrectomy Gray Model 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.



The authors declare no conflict of interest.


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Copyright information

© Society of Surgical Oncology 2013

Authors and Affiliations

  • Takeshi Kubota
    • 1
  • Naoki Hiki
    • 1
  • Takeshi Sano
    • 1
  • Shogo Nomura
    • 2
  • Souya Nunobe
    • 1
  • Koshi Kumagai
    • 1
  • Susumu Aikou
    • 1
  • Ryohei Watanabe
    • 1
  • Toshiyuki Kosuga
    • 1
  • Toshiharu Yamaguchi
    • 1
  1. 1.Department of Gastroenterological SurgeryCancer Institute Hospital, Japanese Foundation for Cancer ResearchKoto-kuJapan
  2. 2.Department of BiostatisticNational Cancer CenterKashiwaJapan

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