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Interaction of Postoperative Morbidity and Receipt of Adjuvant Therapy on Long-Term Survival After Resection for Gastric Adenocarcinoma: Results From the U.S. Gastric Cancer Collaborative

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

Abstract

Background

Postoperative complications (POCs) can negatively impact survival after oncologic resection. POCs may also decrease the rate of adjuvant therapy completion. We evaluated the impact of complications on gastric cancer survival and analyzed the combined effect of complications and adjuvant therapy on survival.

Methods

We analyzed 824 patients from 7 institutions of the U.S. Gastric Cancer Collaborative who underwent curative resection for gastric adenocarcinoma between 2000 and 2012. POC were graded using the modified Clavien–Dindo system. Survival probabilities were estimated using the method of Kaplan and Meier and analyzed using multivariate Cox regression.

Results

Median follow-up was 35 months. The overall complication rate was 41 %. The 5-year overall survival (OS) and recurrence-free survival (RFS) of patients who experienced complications were 27 and 23 %, respectively, compared with 43 and 40 % in patients who did not have complications (p < 0.0001 for OS and RFS). On multivariate analysis, POC remained an independent predictor for decreased OS and RFS (HR 1.3, 95 % CI 1.1–1.6, p = 0.03 for OS; HR 1.3, 95 % CI 1.01–1.6, p = 0.03 for RFS). Patients who experienced POC were less likely to receive adjuvant therapy (OR 0.5, 95 % CI 0.3–0.7, p < 0.001). The interaction of complications and failure to receive adjuvant therapy significantly increased the hazard of death compared with patients who had neither complications nor adjuvant therapy (HR 2.3, 95 % CI 1.6–3.2, p < 0.001).

Conclusions

Postoperative complications adversely affect long-term outcomes after gastrectomy for gastric cancer. Not receiving adjuvant therapy in the face of POC portends an especially poor prognosis following gastrectomy for gastric cancer.

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Authors and Affiliations

  1. Department of Surgery, Barnes Jewish Hospital and The Alvin J. Siteman Cancer Center, Washington University School of Medicine, St. Louis, MO, USA

    Linda X. Jin MD, Dominic E. Sanford MD, MPHS, Lindsey E. Moses MD, Yan Yan MD, PhD, William G. Hawkins MD, David C. Linehan MD, Graham A. Colditz MD, PhD & Ryan C. Fields MD

  2. Division of Surgical Oncology, Department of Surgery, Winship Cancer Institute, Emory University, Atlanta, GA, USA

    Malcolm Hart Squires III MD, Kenneth Cardona MD, David A. Kooby MD & Shishir K. Maithel MD

  3. Department of Surgery, Stanford University Medical Center, Stanford, CA, USA

    George A. Poultsides MD & David J. Worhunsky MD

  4. Department of Surgery, Wake Forest University, Winston-Salem, NC, USA

    Konstantinos I. Votanopoulos MD & Edward A. Levine MD

  5. Department of Surgery, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA

    Sharon M. Weber MD, Alexandra W. Acher MD, Clifford S. Cho MD & Emily Winslow MD

  6. Department of Surgery, The Ohio State University Comprehensive Cancer Center, Columbus, OH, USA

    Mark Bloomston MD, Carl Schmidt MD & Neil Saunders MD

  7. Division of Surgical Oncology, The Johns Hopkins University School of Medicine, Baltimore, MD, USA

    Timothy M. Pawlik MD & Gaya Spolverato MD

Authors
  1. Linda X. Jin MD
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  2. Dominic E. Sanford MD, MPHS
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  3. Malcolm Hart Squires III MD
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  4. Lindsey E. Moses MD
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  5. Yan Yan MD, PhD
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  6. George A. Poultsides MD
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  7. Konstantinos I. Votanopoulos MD
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  8. Sharon M. Weber MD
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  9. Mark Bloomston MD
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  10. Timothy M. Pawlik MD
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  13. Carl Schmidt MD
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  14. David J. Worhunsky MD
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  15. Alexandra W. Acher MD
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  16. Kenneth Cardona MD
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  17. Clifford S. Cho MD
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  18. David A. Kooby MD
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  19. Edward A. Levine MD
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  20. Emily Winslow MD
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  23. Graham A. Colditz MD, PhD
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  24. Shishir K. Maithel MD
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  25. Ryan C. Fields MD
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Corresponding author

Correspondence to Ryan C. Fields MD.

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Jin, L.X., Sanford, D.E., Squires, M.H. et al. Interaction of Postoperative Morbidity and Receipt of Adjuvant Therapy on Long-Term Survival After Resection for Gastric Adenocarcinoma: Results From the U.S. Gastric Cancer Collaborative. Ann Surg Oncol 23, 2398–2408 (2016). https://doi.org/10.1245/s10434-016-5121-7

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  • DOI: https://doi.org/10.1245/s10434-016-5121-7

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