title: Risk factors associated with complication following gastrectomy for gastric cancer: retrospective analysis of prospectively collected data based on the Clavien-Dindo system.
abstract: BACKGROUND
  Most studies about complication after gastric cancer surgery have been performed without consideration of the severity of each complication. The purposes of this study were to prospectively analyze all postgastrectomy complications according to severity using Clavien-Dindo classification and to identify risk factors related to postoperative complications.
  
  
  METHODS
  Complication data were collected prospectively through weekly conferences with all gastric adenocarcinoma patients who underwent gastrectomy between March 2011 and February 2012 at Seoul National University Hospital. Complications were categorized according to the Clavien-Dindo classification.
  
  
  RESULTS
  Out of the 881 patients who underwent gastrectomy, there were 254 events in 197 patients (22.4%). The numbers of grade I, II, IIIa, IIIb, IVa, and V complications according to the Clavien-Dindo classification were 71 (8.1%), 58 (6.6%), 108 (12.3%), 8 (0.9%), 5 (0.6%), and 4 (0.5%), respectively. Extended gastrectomy (odds ratio [OR], 3.92; 95% confidence interval [CI], 1.96-7.82, p < 0.001), total gastrectomy (OR, 1.97; 95% CI, 1.24-3.14, p = 0.004), and age of 60 years or more (OR, 1.66; 95% CI, 1.15-2.38, p = 0.007) were found to be significant independent risk factors for overall complications of gastrectomy. These three factors were also risk factors for the complications of grade IIIa or over and local and systemic complications. In addition, ASA 3 or 4 and moderate or severe malnutrition as well as those three factors were risk factors for systemic complications.
  
  
  CONCLUSIONS
  Age and the extent of gastrectomy were revealed as the prognostic factors for overall complications and the complications of grade IIIa or over according to the Clavien-Dindo classification following gastrectomy for gastric cancer.
authors.affiliation: Department of Surgery, Seoul National University College of Medicine, Seoul, South Korea.
authors.forename: Kyung-Goo
authors.initials: KG
authors.lastname: Lee
authors.forename: Hyuk-Joon
authors.initials: HJ
authors.lastname: Lee
authors.forename: Jun-Young
authors.initials: JY
authors.lastname: Yang
authors.forename: Seung-Young
authors.initials: SY
authors.lastname: Oh
authors.forename: Slava
authors.initials: S
authors.lastname: Bard
authors.forename: Yun-Suhk
authors.initials: YS
authors.lastname: Suh
authors.forename: Seong-Ho
authors.initials: SH
authors.lastname: Kong
authors.forename: Han-Kwang
authors.initials: HK
authors.lastname: Yang
mesh_terms: D000230:Adenocarcinoma / Q000401:mortality* / Q000473:pathology / Q000601:surgery*; D000293:Adolescent; D000328:Adult; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D000704:Analysis of Variance; D001707:Biopsy, Needle; D002423:Cause of Death; D016208:Databases, Factual; D005260:Female; D005500:Follow-Up Studies; D005743:Gastrectomy / Q000009:adverse effects* / Q000379:methods / Q000401:mortality; D006785:Hospitals, University; D006801:Humans; D007150:Immunohistochemistry; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D009361:Neoplasm Invasiveness / Q000473:pathology; D009367:Neoplasm Staging; D011183:Postoperative Complications / Q000401:mortality / Q000503:physiopathology*; D011446:Prospective Studies; D056910:Republic of Korea; D012189:Retrospective Studies; D018570:Risk Assessment; D012737:Sex Factors; D013274:Stomach Neoplasms / Q000401:mortality* / Q000473:pathology / Q000601:surgery*; D016019:Survival Analysis; D013997:Time Factors; D016896:Treatment Outcome; D055815:Young Adult