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01-07-2014 | Original Article

Risk Factors Associated with Complication Following Gastrectomy for Gastric Cancer: Retrospective Analysis of Prospectively Collected Data Based on the Clavien–Dindo System

Authors: Kyung-Goo Lee, Hyuk-Joon Lee, Jun-Young Yang, Seung-Young Oh, Slava Bard, Yun-Suhk Suh, Seong-Ho Kong, Han-Kwang Yang

Published in: Journal of Gastrointestinal Surgery | Issue 7/2014

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.

Conclusion

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.

Park DJ, Lee HJ, Kim HH, Yang HK, Lee KU, Choe KJ. Predictors of operative morbidity and mortality in gastric cancer surgery. Br J Surg 2005; 92:1099–1102PubMedCrossRef

Sano T, Sasako M, Yamamoto S, Nashimoto A, Kurita A, Hiratsuka M, Tsujinaka T, Kinoshita T, Arai K, Yamamura Y, Okajima K. Gastric cancer surgery: morbidity and mortality results from a prospective randomized controlled trial comparing D2 and extended para-aortic lymphadenectomy--Japan Clinical Oncology Group study 9501. J Clin Oncol 2004; 22:2767–2773

Degiuli M, Sasako M, Ponti A; Italian Gastric Cancer Study Group. Morbidity and mortality in the Italian Gastric Cancer Study Group randomized clinical trial of D1 versus D2 resection for gastric cancer. Br J Surg 2010; 97:643–9PubMedCrossRef

Persiani R, Antonacci V, Biondi A, Rausei S, La Greca A, Zoccali M, Ciccoritti L, D’Ugo D. Determinants of surgical morbidity in gastric cancer treatment. J Am Coll Surg 2008; 207:13–19.PubMedCrossRef

Jung MR, Park YK, Seon JW, Kim KY, Cheong O, Ryu SY. Definition and classification of complications of gastrectomy for gastric cancer based on the accordion severity grading system. World J Surg 2012; 36:2400–2411.PubMedCrossRef

Clavien PA, Barkun J, de Oliveira ML, Vauthey JN, Dindo D, Schulick RD, de Santibañes E, Pekolj J, Slankamenac K, Bassi C, Graf R, Vonlanthen R, Padbury R, Cameron JL, Makuuchi M. The Clavien–Dindo classification of surgical complications:five-year experience. Ann Surg 2009; 250:187–196.PubMedCrossRef

Dindo D, Demartines N, Clavien PA. Classification of surgical complications: a new proposal with evaluation in a cohort of 6336 patients and results of a survey. Ann Surg 2004; 240:205–213.PubMedCentralPubMedCrossRef

Hayashi T, Yoshikawa T, Aoyama T, Ogata T, Cho H, Tsuburaya A. Severity of complications after gastrectomy in elderly patients with gastric cancer. World J Surg 2012;36 :2139–45PubMedCrossRef

Braga M, Capretti G, Pecorelli N, Balzano G, Doglioni C, Ariotti R, Di Carlo V. A prognostic score to predict major complications after pancreaticoduodenectomy. Ann Surg 2011;254 :702–7PubMedCrossRef

10.

Gonzalgo ML, Pavlovich CP, Trock BJ, Link RE, Sullivan W, Su LM. Classification and trends of perioperative morbidities following laparoscopic radical prostatectomy. J Urol 2005;174 :135–139PubMedCrossRef

11.

Pata G, Solaini L, Roncali S, Pasini M, Ragni F. Total gastrectomy with “over-D1” lymph node dissection: what is the actual impact of age? Am J Surg. 2012;204 : 732–740PubMedCrossRef

12.

Lee JH, Park do J, Kim HH, Lee HJ, Yang HK. Comparison of complications after laparoscopy-assisted distal gastrectomy and open distal gastrectomy for gastric cancer using the Clavien–Dindo classification. Surg Endosc 2011; 26:1287–1295

13.

Jiang X, Hiki N, Nunobe S, Fukunaga T, Kumagai K, Nohara K, Sano T, Yamaguchi T. Postoperative outcomes and complications after laparoscopy-assisted pylorus-preserving gastrectomy for early gastric cancer. Ann Surg 2011; 253:928–933PubMedCrossRef

14.

Kumagai K, Hiki N, Nunobe S, Jiang X, Kubota T, Aikou S, Watanabe R, Tanimura S, Sano T, Kitagawa Y, Yamaguchi T. Different features of complications with Billroth I and Roux-en-Y reconstruction after laparoscopic-assisted distal gastrectomy. J Gastrointest Surg 2011; 15:2145–2152PubMedCrossRef

15.

Japanese Gastric Cancer Association. Japanese gastric cancer treatment guidelines 2010 (ver. 3). Gastric Cancer 2011 ;14 :113–23.CrossRef

16.

Yang HK, Lee HJ, Ahn HS, Yoo MW, Lee IK, Lee KU. Safety of modified double-stapling end-to-end gastroduodenostomy in distal subtotal gastrectomy. J Surg Oncol 2007; 96:624–9.PubMedCrossRef

17.

Kim Y, Kim WG, Lee HJ, Park MS, Lee YH, Cho JJ, Kong SH, Yang HK. Impact of malnutrition Risk Determined by Nutrition Screening Index on Operative Morbidity after Gastric Cancer Surgery. J Korean Surg Soc 2011; 80:1–9.CrossRef

18.

Bae HJ, Lee HJ, Han DS, Suh YS, Lee YH, Lee HS, Cho JJ, Kong SH, Yang HK. Prealbumin levels as a useful marker for predicting infectious complications after gastric surgery. J Gastrointest Surg. 2011 Dec;15(12):2136–44

19.

Bellomo R, Ronco C, Kellum JA, Mehta RL, Palevsky P; Acute Dialysis Quality Initiative workgroup. Acute renal failure - definition, outcome measures, animal models, fluid therapy and information technology needs: the Second International Consensus Conference of the Acute Dialysis Quality Initiative (ADQI) Group. Crit Care. 2004 Aug;8(4):R204-12.

20.

Bozzetti F, Marubini E, Bonfanti G, Miceli R, Piano C, Crose N, Gennari L. Total versus subtotal gastrectomy: surgical morbidity and mortality rates in a multicenter Italian randomized trial. The Italian Gastrointestinal Tumor Study Group. Ann Surg 1997;226 :613–620.PubMedCentralPubMedCrossRef

21.

Degiuli M, Sasako M, Ponti A, Soldati T, Danese F, Calvo F. Morbidity and mortality after D2 gastrectomy for gastric cancer: results of the Italian Gastric Cancer Study Group prospective multicenter surgical study. J Clin Oncol 1998;16 :1490–1493PubMed

22.

Jeong O, Park YK, Ryu SY, Kim YJ. Effect of age on surgical outcomes of extended gastrectomy with D2 lymph node dissection in gastric carcinoma: prospective cohort study. Ann Surg Oncol 2010 Jun;17 :1589–96

23.

Gretschel S, Estevez-Schwarz L, Hünerbein M, Schneider U, Schlag PM. Gastric cancer surgery in elderly patients. WorldJSurg 2006;30 :1468–74

24.

Jeong SH, Ahn HS, Yoo MW, Cho JJ, Lee HJ, Kim HH, Lee KU, Yang HK. Increased morbidity rates in patients with heart disease or chronic liver disease following radical gastric surgery. J SurgOncol 2010;101 :200–204

25.

Kim MC, Kim W, Kim HH, Ryu SW, Ryu SY, Song KY, Lee HJ, Cho GS, Han SU, Hyung WJ ; Korean Laparoscopic Gastrointestinal Surgery Study (KLASS) Group. Risk factors associated with complication following laparoscopy-assisted gastrectomy for gastric cancer: a large-scale korean multicenter study. Ann Surg Oncol 2008;15 :2692–2700.PubMedCrossRef

26.

Gretschel S, Christoph F, Bembenek A, Estevez-Schwarz L, Schneider U, Schlag PM. Body mass index does not affect systemic D2 lymph node dissection and postoperative morbidity in gastric cancer patients. Ann Surg Oncol 2003;10 :363–8PubMedCrossRef

27.

Bickenbach KA, Denton B, Gonen M, Brennan MF, Coit DG, Strong VE. Impact of obesity on perioperative complications and long-term survival of patients with gastric cancer. Ann Surg Oncol 2013;20 :780–7.PubMedCrossRef

28.

Warnold I, Lundholm K. Clinical significance of preoperative nutritional status in 215 noncancer patients. Ann Surg 1984;199 :299–305PubMedCentralPubMedCrossRef

29.

Gibbs J, Cull W, Henderson W, Daley J, Hur K, Khuri SF. Preoperative serum albumin level as a predictor of operative mortality and morbidity. Arch Surg 1999;134 :36–42.PubMedCrossRef

30.

Wu MH, Lin MT, Chen WJ. Effect of perioperative parenteral nutritional support for gastric cancer patients undergoing gastrectomy. Hepatogastroenterology 2008;55 :799–802PubMed

31.

Martin RC 2nd, Jaques DP, Brennan MF, Karpeh M. Extended local resection for advanced gastric cancer: increased survival versus increased morbidity. Ann Surg 2002;236 :159–65.PubMedCentralPubMedCrossRef

32.

Ozer I, Bostanci EB, Orug T, Ozogul YB, Ulas M, Ercan M, Kece C, Atalay F, Akoglu M. Surgical outcomes and survival after multiorgan resection for locally advanced gastric cancer. Am J Surg. 2009;198(1):25–30PubMedCrossRef

33.

Pacelli F, Cusumano G, Rosa F, Marrelli D, Dicosmo M, Cipollari C, Marchet A, Scaringi S, Rausei S, di Leo A, Roviello F, de Manzoni G, Nitti D, Tonelli F, Doglietto GB; Italian Research Group for Gastric Cancer. Multivisceral resection for locally advanced gastric cancer: an Italian multicenter observational study. JAMA Surg. 2013; 148(4):353–60PubMedCrossRef

Title: Risk Factors Associated with Complication Following Gastrectomy for Gastric Cancer: Retrospective Analysis of Prospectively Collected Data Based on the Clavien–Dindo System
Authors: Kyung-Goo Lee
Hyuk-Joon Lee
Jun-Young Yang
Seung-Young Oh
Slava Bard
Yun-Suhk Suh
Seong-Ho Kong
Han-Kwang Yang
Publication date: 01-07-2014
Publisher: Springer US
Published in: Journal of Gastrointestinal Surgery / Issue 7/2014
Print ISSN: 1091-255X
Electronic ISSN: 1873-4626
DOI: https://doi.org/10.1007/s11605-014-2525-1

At a glance: The ONWARDS insulin icodec trials

Springer Medicine

Risk Factors Associated with Complication Following Gastrectomy for Gastric Cancer: Retrospective Analysis of Prospectively Collected Data Based on the Clavien–Dindo System

Abstract

Background

Methods

Results

Conclusion

At a glance: The ONWARDS insulin icodec trials

Springer Medicine

Abstract

Background

Methods

Results

Conclusion

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