Poor survival rate in patients with postoperative intra-abdominal infectious complications following curative gastrectomy for gastric cancer.
BACKGROUND
The impact of postoperative complications on recurrence rate and long-term outcome has been reported in patients with colorectal and esophageal cancer, but not in patients with gastric cancer. This study evaluated the impact of postoperative intra-abdominal infectious complications on long-term survival following curative gastrectomy.


METHODS
This study included 765 patients who underwent curative gastrectomy for gastric cancer between 2002 and 2006. Patients were divided into 2 groups: with (C-group, n = 81) or without (NC-group, n = 684) intra-abdominal infectious complications. Survival curves were compared between the groups, and multivariate analysis was conducted to identify independent prognostic factors.


RESULTS
Male patients were dominant, and total gastrectomy was frequently performed in the C-group. The pathological stage was more advanced and D2 lymph node dissection and splenectomy were preferred in the C-group. The 5-year overall survival (OS) rate was better in the NC-group (86.8 %) than in the C-group (66.4 %; P < .001). The 5-year relapse-free survival (RFS) rate was also better in the NC-group (84.5 %) than in the C-group (64.9 %; P < .001). This trend was still observed in stage II and III patients after stratification by pathological stage. Multivariate analysis identified intra-abdominal infectious complication as an independent prognostic factor for OS (hazard ratio, 2.448; 95 % confidence interval [95 % CI], 1.475-4.060) and RFS (hazard ratio, 2.219; 95 % CI, 1.330-3.409) in patients with advanced disease.


CONCLUSIONS
Postoperative intra-abdominal infectious complications adversely affect OS and RFS. Meticulous surgery is needed to decrease the complication rate and improve the long-term outcome of patients following curative gastrectomy.
Division of Gastric Surgery, Shizuoka Cancer Center, Shizuoka, Japan. m.tokunaga@scchr.jp
Masanori
M
Tokunaga
Yutaka
Y
Tanizawa
Etsuro
E
Bando
Taiichi
T
Kawamura
Masanori
M
Terashima
D018784:Abdominal Abscess / Q000382:microbiology*; D000230:Adenocarcinoma / Q000556:secondary / Q000601:surgery*; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D057868:Anastomotic Leak / Q000209:etiology*; D016063:Blood Loss, Surgical; D002764:Cholecystitis / Q000209:etiology; D018572:Disease-Free Survival; D005260:Female; D005743:Gastrectomy / Q000009:adverse effects*; D006801:Humans; D007415:Intestinal Obstruction / Q000209:etiology; D053208:Kaplan-Meier Estimate; D008297:Male; D044342:Malnutrition / Q000209:etiology; D008875:Middle Aged; D061646:Operative Time; D010182:Pancreatic Diseases / Q000382:microbiology*; D010359:Patient Readmission; D011183:Postoperative Complications / Q000145:classification; D016016:Proportional Hazards Models; D012189:Retrospective Studies; D013274:Stomach Neoplasms / Q000473:pathology / Q000601:surgery*; D015996:Survival Rate; D055815:Young Adult