title: Impact of postoperative complications on long-term survival after radical resection for gastric cancer.
abstract: OBJECTIVE
  To investigate the potential impact of complications in gastric cancer patients who survive the initial postoperative period.
  
  
  METHODS
  Between January 1, 2005 and December 31, 2006, 432 patients who received curative gastrectomy with D2 lymph node dissection for gastric cancer at our department were studied. Associations between clinicopathological factors [age, sex, American Society of Anesthesiologists grade, body mass index, tumor-node-metastases (TNM) stage and tumor grade], including postoperative complications (defined as any deviation from an uneventful postoperative course within 30 d of the operation and survival rates) and treatment-specific factors (blood transfusion, neoadjuvant therapy and duration of surgery). Patients were divided into 2 groups: with (n = 54) or without (n = 378) complications. Survival curves were compared between the groups, and univariate and multivariate models were conducted to identify independent prognostic factors.
  
  
  RESULTS
  Among the 432 patients evaluated, 61 complications occurred affecting 54 patients (12.50%). Complications included anastomotic leakages, gastric motility disorders, anastomotic block, wound infections, intra-abdominal abscesses, infectious diarrhea, bleeding, bowel obstructions, arrhythmias, angina pectoris, pneumonia, atelectasis, thrombosis, unexplained fever, delirium, ocular fungal infection and multiple organ failure. American Society of Anesthesiologists grade, body mass index, combined organ resection and median duration of operation were associated with higher postoperative complications. The 1-, 3- and 5-year survival rates were 83.3%, 53.2% and 37.5%, respectively. In the univariate analysis, the size of lesions, TNM stage, blood transfusion, lymphovascular invasion, perineural invasion, neoadjuvant chemotherapy, and postoperative complications were significant predictors of overall survival. In the multivariate analysis, only TNM stage and the presence of complications remained significant predictors of reduced survival.
  
  
  CONCLUSIONS
  The occurrence of in-hospital postoperative complications was an independent predictor of worse 5-year overall survival rate after radical resection of gastric cancer.
authors.affiliation: Department of Gastrointestinal Surgery, Subei People's Hospital of Jiangsu Province (the First Affiliated Hospital of Yangzhou University), Yangzhou 225001, Jiangsu Province, China.
authors.forename: Qing-Guo
authors.initials: QG
authors.lastname: Li
authors.forename: Ping
authors.initials: P
authors.lastname: Li
authors.forename: Dong
authors.initials: D
authors.lastname: Tang
authors.forename: Jie
authors.initials: J
authors.lastname: Chen
authors.forename: Dao-Rong
authors.initials: DR
authors.lastname: Wang
mesh_terms: D000230:Adenocarcinoma / Q000401:mortality* / Q000601:surgery*; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D005500:Follow-Up Studies; D005743:Gastrectomy; D005767:Gastrointestinal Diseases / Q000150:complications; D006470:Hemorrhage / Q000150:complications; D006801:Humans; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D011183:Postoperative Complications / Q000209:etiology / Q000503:physiopathology*; D011379:Prognosis; D012189:Retrospective Studies; D013274:Stomach Neoplasms / Q000401:mortality* / Q000601:surgery*; D013530:Surgical Wound Infection / Q000150:complications; D015996:Survival Rate; D016896:Treatment Outcome
keywords: Complications; Gastric cancer; Perioperative complication; Surgical resection