title: Postoperative complications do not impact on recurrence and survival after curative resection of gastric cancer.
abstract: BACKGROUND
  We assessed the impact of complications on recurrence and survival after curative gastric cancer resection.
  
  
  METHODS
  Patients undergoing R0 resections between 1990 and 2009 were identified in a prospectively maintained database and were categorized by presence of any complication Clavien-Dindo (CD) ≥ II, sepsis or intra-abdominal sepsis. Cox regression analyses to relate complications and clinico-pathological variables to time to recurrence (TTR) and overall survival (OS) were performed.
  
  
  RESULTS
  A total of 271 patients were included with a median follow-up of 149.9 months (range 140.1-159.9). Complications CD ≥ II occurred in 162 (59.8%) patients, sepsis in 66 (22.5%), and intra-abdominal sepsis in 37 (13.6%). Recurrence developed in 88 (32.4%) patients. Independent predictors of short TTR were pTNM stage (IIIB-IIIC vs. IA-IIA) (hazard ratio [HR] = 37.55, 95% confidence interval [CI] 17.57-80.24; p < 0.001), D1 lymphadenectomy (HR = 3.14, 95% CI 1.94-5.07; p < 0.001), and male gender (HR = 1.65, 95% CI 1.06-2.57; p = 0.026). pTNM stage (IIIB-IIIC vs. IA-IIA, HR = 10.28, 95% CI 6.51-16.23; p < 0.001), male gender (HR = 1.64, 95% CI 1.17-2.31; p = 0.005), age (HR = 1.03, 95% CI 1.02-1.05; p < 0.001), and adjuvant therapy (HR = 0.55, 95% CI 0.37-0.83; p = 0.004) were identified as independent predictors of OS..
  
  
  CONCLUSIONS
  Evidence provided by this study does not support a negative impact of postoperative complications CD ≥ II, sepsis, and intra-abdominal sepsis on the oncologic outcome after curative gastric cancer resection.
authors.affiliation: Section of Gastrointestinal Surgery, Hospital Universitario del Mar, IMIM (Institut Hospital del Mar d'Investigacions Mèdiques), Universitat Autónoma de Barcelona, Barcelona, Spain.
authors.forename: M
authors.initials: M
authors.lastname: Climent
authors.affiliation: Department of General and Digestive Surgery, Hospital Clínic, Universitat de Barcelona, Barcelona, Spain.
authors.forename: N
authors.initials: N
authors.lastname: Hidalgo
authors.affiliation: Department of General and Digestive Surgery, Hospital Clínic, Universitat de Barcelona, Barcelona, Spain.
authors.forename: Ó
authors.initials: Ó
authors.lastname: Vidal
authors.affiliation: Section of Gastrointestinal Surgery, Hospital Universitario del Mar, IMIM (Institut Hospital del Mar d'Investigacions Mèdiques), Universitat Autónoma de Barcelona, Barcelona, Spain.
authors.forename: S
authors.initials: S
authors.lastname: Puig
authors.affiliation: Service of Pathology, Hospital Universitario del Mar, Barcelona, Spain.
authors.forename: M
authors.initials: M
authors.lastname: Iglesias
authors.affiliation: Service of Pathology, Hospital Clínic, Barcelona, Spain.
authors.forename: M
authors.initials: M
authors.lastname: Cuatrecasas
authors.affiliation: Section of Gastrointestinal Surgery, Hospital Universitario del Mar, IMIM (Institut Hospital del Mar d'Investigacions Mèdiques), Universitat Autónoma de Barcelona, Barcelona, Spain.
authors.forename: J M
authors.initials: JM
authors.lastname: Ramón
authors.affiliation: Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, USA.
authors.forename: X
authors.initials: X
authors.lastname: García-Albéniz
authors.affiliation: Section of Gastrointestinal Surgery, Hospital Universitario del Mar, IMIM (Institut Hospital del Mar d'Investigacions Mèdiques), Universitat Autónoma de Barcelona, Barcelona, Spain.
authors.forename: L
authors.initials: L
authors.lastname: Grande
authors.affiliation: Section of Gastrointestinal Surgery, Hospital Universitario del Mar, IMIM (Institut Hospital del Mar d'Investigacions Mèdiques), Universitat Autónoma de Barcelona, Barcelona, Spain. Electronic address: pera@parcdesalutmar.cat.
authors.forename: M
authors.initials: M
authors.lastname: Pera
mesh_terms: D000230:Adenocarcinoma / Q000401:mortality* / Q000473:pathology / Q000601:surgery*; D000368:Aged; D000369:Aged, 80 and over; D016208:Databases, Factual; D018572:Disease-Free Survival; D005260:Female; D005743:Gastrectomy / Q000009:adverse effects / Q000379:methods; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000401:mortality* / Q000473:pathology; D011183:Postoperative Complications / Q000401:mortality* / Q000503:physiopathology; D016016:Proportional Hazards Models; D012189:Retrospective Studies; D018570:Risk Assessment; D013030:Spain; D013274:Stomach Neoplasms / Q000401:mortality* / Q000473:pathology / Q000601:surgery*; D016019:Survival Analysis
keywords: Gastric cancer; Postoperative complications; Recurrence; Survival