title: Risk Model for Distal Gastrectomy When Treating Gastric Cancer on the Basis of Data From 33,917 Japanese Patients Collected Using a Nationwide Web-based Data Entry System.
abstract: OBJECTIVE
  To establish a risk model for distal gastrectomy in Japanese patients with gastric cancer.
  
  
  BACKGROUND
  Risk stratification for distal gastrectomy in Japanese patients with gastric cancer improves surgical outcomes.
  
  
  METHODS
  The National Clinical Database was constructed for risk determination in gastric cancer-related gastrectomy among Japanese individuals. Data from 33,917 gastric cancer cases (1737 hospitals) were used. The primary outcomes were 30-day and operative mortalities. Data were randomly assigned to risk model development (27,220 cases) and test validation (6697 cases) subsets. Stepwise selection was used for constructing 30-day and operative mortality logistic models.
  
  
  RESULTS
  The 30-day, in-hospital, and operative mortality rates were 0.52%, 1.16%, and 1.2%, respectively. The morbidity was 18.3%. The 30-day and operative mortality models included 17 and 21 risk factors, respectively. Thirteen variables overlapped: age, need for total assistance in activities of daily living preoperatively or within 30 days after surgery, cerebrovascular disease history, more than 10% weight loss, uncontrolled ascites, American Society of Anesthesiologists score (≥ class 3), white blood cell count more than 12,000/μL or 11,000/μL, anemia (hemoglobin: males, <13.5 g/dL; females, <12.5 g/dL; or hematocrit: males, <37%; females <32%), serum albumin less than 3.5 or 3.8 g/dL, alkaline phosphatase more than 340 IU/L, serum creatinine more than 1.2 mg/dL, serum Na less than 135 mEq/L, and prothrombin time-international normalized ratio more than 1.25 or 1.1. The C-indices for the 30-day and operative mortalities were 0.785 (95% confidence interval, 0.705-0.865; P < 0.001) and 0.798 (95% confidence interval, 0.746-0.851; P < 0.001), respectively.
  
  
  CONCLUSIONS
  The risk model developed using nationwide Japanese data on distal gastrectomy in gastric cancer can predict surgical outcomes.
authors.affiliation: *Japanese Society of Gastroenterological Surgery, Tokyo, Japan †Japanese Society of Gastroenterological Surgery, Database Committee, Tokyo, Japan ‡National Clinical Database, Tokyo, Japan §Japanese Society of Gastroenterological Surgery, Working Group of Database Committee, Tokyo, Japan.
authors.forename: Nobuhiro
authors.initials: N
authors.lastname: Kurita
authors.forename: Hiroaki
authors.initials: H
authors.lastname: Miyata
authors.forename: Mitsukazu
authors.initials: M
authors.lastname: Gotoh
authors.forename: Mitsuo
authors.initials: M
authors.lastname: Shimada
authors.forename: Satoru
authors.initials: S
authors.lastname: Imura
authors.forename: Wataru
authors.initials: W
authors.lastname: Kimura
authors.forename: Naohiro
authors.initials: N
authors.lastname: Tomita
authors.forename: Hideo
authors.initials: H
authors.lastname: Baba
authors.forename: Yukou
authors.initials: Y
authors.lastname: Kitagawa
authors.forename: Kenichi
authors.initials: K
authors.lastname: Sugihara
authors.forename: Masaki
authors.initials: M
authors.lastname: Mori
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D005743:Gastrectomy / Q000009:adverse effects* / Q000401:mortality; D017052:Hospital Mortality; D006801:Humans; D020407:Internet; D007564:Japan / Q000453:epidemiology; D010535:Laparoscopy / Q000009:adverse effects* / Q000401:mortality; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D016017:Odds Ratio; D019984:Quality Indicators, Health Care / Q000706:statistics & numerical data; D012307:Risk Factors; D012680:Sensitivity and Specificity; D013274:Stomach Neoplasms / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D015996:Survival Rate; D016896:Treatment Outcome