title: Prognostic significance of complications after curative surgery for gastric cancer.
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.
authors.affiliation: Department of Gastroenterological Surgery, Cancer Institute Hospital, Japanese Foundation for Cancer Research, Koto-ku, Tokyo, Japan.
authors.forename: Takeshi
authors.initials: T
authors.lastname: Kubota
authors.forename: Naoki
authors.initials: N
authors.lastname: Hiki
authors.forename: Takeshi
authors.initials: T
authors.lastname: Sano
authors.forename: Shogo
authors.initials: S
authors.lastname: Nomura
authors.forename: Souya
authors.initials: S
authors.lastname: Nunobe
authors.forename: Koshi
authors.initials: K
authors.lastname: Kumagai
authors.forename: Susumu
authors.initials: S
authors.lastname: Aikou
authors.forename: Ryohei
authors.initials: R
authors.lastname: Watanabe
authors.forename: Toshiyuki
authors.initials: T
authors.lastname: Kosuga
authors.forename: Toshiharu
authors.initials: T
authors.lastname: Yamaguchi
mesh_terms: D000230:Adenocarcinoma / Q000150:complications / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D000368:Aged; D005260:Female; D005500:Follow-Up Studies; D005743:Gastrectomy / Q000009:adverse effects / Q000401:mortality*; D006801:Humans; D008197:Lymph Node Excision / Q000009:adverse effects / Q000401:mortality*; D008297:Male; D009367:Neoplasm Staging; D011183:Postoperative Complications / Q000209:etiology / Q000401:mortality*; D011379:Prognosis; D013274:Stomach Neoplasms / Q000150:complications / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D015996:Survival Rate