title: Improvement in postoperative mortality in elective gastrectomy for gastric cancer: Analysis of predictive factors in 1066 patients from a single centre.
abstract: BACKGROUND
  Gastrectomy represents the main treatment for gastric adenocarcinoma. This procedure is associated with substantial morbidity and mortality. The aim of this study was to evaluate the postoperative mortality changes across the study period and to identify predictive factors of 30-day mortality after elective gastrectomy for gastric cancer.
  
  
  METHODS
  This was a retrospective cohort study of a prospective database from a single centre. Patients treated with an elective gastrectomy from 1996 to 2014 for gastric adenocarcinoma were included. We compared postoperative mortality between four time periods: 1996-2000, 2001-2005, 2006-2010, and 2011-2014. Univariate and multivariate analyses were applied to identify predictors of 30-day postoperative mortality.
  
  
  RESULTS
  We included 1066 patients (median age 65 years; 67% male). The 30-day mortality rate was 4.7%. Mortality decreased across the four time periods; from 6.5% to 1.8% (P = 0.022). In the univariate analysis, age, ASA score, albumin <3.5, multivisceral resection, splenectomy, intrathoracic esophagojejunal anastomosis, R status, and T status were significantly associated with postoperative mortality. In the multivariate analysis, ASA class 3 (OR 10.06; CI 1.97-51.3; P = 0.005) and multivisceral resection (OR 1.6; CI 1.09-2.36; P = 0.016) were associated with higher postoperative 30-day mortality; surgery between 2011 and 2014 was associated with lower postoperative 30-day mortality (OR 0.55; CI 0.33-0.15; P = 0.030).
  
  
  CONCLUSIONS
  There was a decrease in postoperative 30-day mortality during this 18-year period at our institution. We have identified ASA score and multivisceral resection as predictors of 30-day mortality for elective gastrectomy for cancer.
authors.affiliation: Hospital Dr. Sotero del Rio, Esophagogastric Surgery Unit, Digestive Surgery Department, Pontificia Universidad Católica de Chile, Chile. Electronic address: enorero@uc.cl.
authors.forename: E
authors.initials: E
authors.lastname: Norero
authors.affiliation: Hospital Dr. Sotero del Rio, Esophagogastric Surgery Unit, Digestive Surgery Department, Pontificia Universidad Católica de Chile, Chile.
authors.forename: E A
authors.initials: EA
authors.lastname: Vega
authors.affiliation: Hospital Dr. Sotero del Rio, Esophagogastric Surgery Unit, Digestive Surgery Department, Pontificia Universidad Católica de Chile, Chile.
authors.forename: C
authors.initials: C
authors.lastname: Diaz
authors.affiliation: Epidemiology Department, Faculty of Medicine Universidad de los Andes and Public Health School, Faculty of Medicine, Universidad de Chile, Chile.
authors.forename: G
authors.initials: G
authors.lastname: Cavada
authors.affiliation: Hospital Dr. Sotero del Rio, Esophagogastric Surgery Unit, Digestive Surgery Department, Pontificia Universidad Católica de Chile, Chile.
authors.forename: M
authors.initials: M
authors.lastname: Ceroni
authors.affiliation: Hospital Dr. Sotero del Rio, Esophagogastric Surgery Unit, Digestive Surgery Department, Pontificia Universidad Católica de Chile, Chile.
authors.forename: C
authors.initials: C
authors.lastname: Martínez
authors.affiliation: Hospital Dr. Sotero del Rio, Esophagogastric Surgery Unit, Digestive Surgery Department, Pontificia Universidad Católica de Chile, Chile.
authors.forename: E
authors.initials: E
authors.lastname: Briceño
authors.affiliation: Hospital Dr. Sotero del Rio, Esophagogastric Surgery Unit, Digestive Surgery Department, Pontificia Universidad Católica de Chile, Chile.
authors.forename: F
authors.initials: F
authors.lastname: Araos
authors.affiliation: Hospital Dr. Sotero del Rio, Esophagogastric Surgery Unit, Digestive Surgery Department, Pontificia Universidad Católica de Chile, Chile.
authors.forename: P
authors.initials: P
authors.lastname: Gonzalez
authors.affiliation: Hospital Dr. Sotero del Rio, Esophagogastric Surgery Unit, Digestive Surgery Department, Pontificia Universidad Católica de Chile, Chile.
authors.forename: S
authors.initials: S
authors.lastname: Baez
authors.affiliation: Hospital Dr. Sotero del Rio, Esophagogastric Surgery Unit, Digestive Surgery Department, Pontificia Universidad Católica de Chile, Chile.
authors.forename: E
authors.initials: E
authors.lastname: Vinuela
authors.affiliation: Hospital Dr. Sotero del Rio, Esophagogastric Surgery Unit, Digestive Surgery Department, Pontificia Universidad Católica de Chile, Chile.
authors.forename: M
authors.initials: M
authors.lastname: Caracci
authors.affiliation: Hospital Dr. Sotero del Rio, Esophagogastric Surgery Unit, Digestive Surgery Department, Pontificia Universidad Católica de Chile, Chile.
authors.forename: A
authors.initials: A
authors.lastname: Diaz
mesh_terms: D000230:Adenocarcinoma / Q000601:surgery*; D000368:Aged; D000369:Aged, 80 and over; D003082:Colectomy; D017558:Elective Surgical Procedures / Q000401:mortality*; D005260:Female; D005743:Gastrectomy / Q000401:mortality*; D006498:Hepatectomy; D006801:Humans; D008297:Male; D009026:Mortality / Q000639:trends; D010180:Pancreatectomy; D012189:Retrospective Studies; D012307:Risk Factors; D012720:Severity of Illness Index; D013156:Splenectomy; D013274:Stomach Neoplasms / Q000601:surgery*
keywords: Adenocarcinoma; Gastrectomy; Mortality; Risk factors; Stomach neoplasms