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  • Title: Poor survival rate in patients with postoperative intra-abdominal infectious complications following curative gastrectomy for gastric cancer.
    Author: Tokunaga M, Tanizawa Y, Bando E, Kawamura T, Terashima M.
    Journal: Ann Surg Oncol; 2013 May; 20(5):1575-83. PubMed ID: 23076557.
    Abstract:
    BACKGROUND: The impact of postoperative complications on recurrence rate and long-term outcome has been reported in patients with colorectal and esophageal cancer, but not in patients with gastric cancer. This study evaluated the impact of postoperative intra-abdominal infectious complications on long-term survival following curative gastrectomy. METHODS: This study included 765 patients who underwent curative gastrectomy for gastric cancer between 2002 and 2006. Patients were divided into 2 groups: with (C-group, n = 81) or without (NC-group, n = 684) intra-abdominal infectious complications. Survival curves were compared between the groups, and multivariate analysis was conducted to identify independent prognostic factors. RESULTS: Male patients were dominant, and total gastrectomy was frequently performed in the C-group. The pathological stage was more advanced and D2 lymph node dissection and splenectomy were preferred in the C-group. The 5-year overall survival (OS) rate was better in the NC-group (86.8 %) than in the C-group (66.4 %; P < .001). The 5-year relapse-free survival (RFS) rate was also better in the NC-group (84.5 %) than in the C-group (64.9 %; P < .001). This trend was still observed in stage II and III patients after stratification by pathological stage. Multivariate analysis identified intra-abdominal infectious complication as an independent prognostic factor for OS (hazard ratio, 2.448; 95 % confidence interval [95 % CI], 1.475-4.060) and RFS (hazard ratio, 2.219; 95 % CI, 1.330-3.409) in patients with advanced disease. CONCLUSIONS: Postoperative intra-abdominal infectious complications adversely affect OS and RFS. Meticulous surgery is needed to decrease the complication rate and improve the long-term outcome of patients following curative gastrectomy.
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