Abstract
We focused on the impact of postoperative infection on long-term survival after potentially curative resection for gastric cancer. Postoperative surgical and medical complications have been implicated as a negative predictor of long-term outcome in various malignancies. However, there have been no published reports assessing the impact of complications arising from postoperative infection on survival in gastric cancer. We studied a population of 1,332 patients who underwent curative resection for gastric cancer. These patients were divided into two groups based on the occurrence (141 patients, 10.6%) or absence (1,191 patients, 89.4%) of postoperative complications due to infection. We investigated the demographic and clinicopathological features of each patient with and without postoperative complications from infection, and thereby the impact of postoperative infection on long-term survival. Patients with postoperative infection had significantly higher frequency of males, upper side tumor location, and total gastrectomy as a surgical procedure, more advanced stage of gastric cancer, and greater age compared with those without postoperative infection. Patients with complications due to postoperative infection had significantly more unfavorable outcome compared with those patients without postoperative infection. Multivariate analysis demonstrated that age, preoperative comorbidity, blood transfusion, tumor depth, nodal involvement, and postoperative infection correlated with overall survival. We conclude that postoperative complications from infection are a predictor of adverse clinical outcome in patients with gastric cancer. However, further immunological study and prospective trials are necessary to confirm the biological significance of these findings.
Similar content being viewed by others
References
Collins TC, Daley J, Henderson WH, Khuri SF. Risk factors for prolonged length of stay after major elective surgery. Ann Surg. 1999;230:251–9.
Tsutsui S, Moriguchi S, Morita M, et al. Multivariate analysis of postoperative complications after esophageal resection. Ann Thorac Surg. 1992;53:1052–6.
DerHagopian RP, Sugarbaker EV, Ketcham A. Inflammatory oncotaxis. JAMA 1978;240:374–5.
Nowacki MP, Szymendera JJ. The strongest prognostic factors in colorectal carcinoma. Surgicopathologic stage of disease and postoperative fever. Dis Colon Rectum. 1983;26:263–8.
Hirai T, Yamashita Y, Mukaida H, Kuwahara M, Inoue H, Toge T. Poor prognosis in esophageal cancer patients with postoperative complications. Surg Today. 1998;28:576–9.
Lagarde SM, de Boer JD, ten Kate FJ, Busch OR, Obertop H, van Lanschot JJ. Postoperative complications after esophagectomy for adenocarcinoma of the esophagus are related to timing of death due to recurrence. Ann Surg. 2008;247:71–6.
Fucini C, Bandettini L, D’Elia M, Filipponi F, Herd-Smith A. Are postoperative fever and/or septic complications prognostic factors in colorectal cancer resected for cure? Dis Colon Rectum. 1985;28:94–5.
Akyol AM, McGregor JR, Galloway DJ, Murray GD, George WD. Anastomotic leaks in colorectal cancer surgery: a risk factor for recurrence? Int J Colorectal Dis. 1991;6:179–83.
Nespoli A, Gianotti L, Totis M, Bovo G, Nespoli L, Chiodini P, et al. Correlation between postoperative infections and long-term survival after colorectal resection for cancer. Tumori. 2004;90:485–90.
Sensenig DM, Rossi NP, Ehrenhaft JL. Results of the surgical treatment of bronchogenic carcinoma. Surg Gynecol Obstet. 1963;116:279–84.
Ruckdeschel JC, Codish SD, Stranahan A, McKneally MF. Postoperative empyema improves survival in lung cancer. Documentation and analysis of a natural experiment. N Engl J Med. 1972;287:1013–7.
Dionigi R, Dominioni L, Campani M. Infections in cancer patients. Surg Clin North Am. 1980;60:145–59.
Wigmore SJ, McMahon AJ, Sturgeon CM, Fearon KC. Acute-phase protein response, survival and tumour recurrence in patients with colorectal cancer. Br J Surg. 2001;88:255–60.
Varty PP, Linehan IP, Boulos PB. Intra-abdominal sepsis and survival after surgery for colorectal cancer. Br J Surg. 1994;81:915–8.
Sobin LH, Fleming ID. TNM Classification of Malignant Tumors. 5th ed (1997). Union Internationale Contre le Cancer and the American Joint Committee on Cancer. Cancer. 1997;80:1803–4.
Walker KG, Bell SW, Rickard MJ, Mehanna D, Dent OF, Chapuis PH, et al. Anastomotic leakage is predictive of diminished survival after potentially curative resection for colorectal cancer. Ann Surg. 2004;240:255–9.
Dranoff G. Cytokines in cancer pathogenesis and cancer therapy. Nat Rev Cancer. 2004;4:11–22.
Perwez Hussain S, Harris CC. Inflammation and cancer: an ancient link with novel potentials. Int J Cancer. 2007;121:2373–80.
Smyth MJ, Cretney E, Kershaw MH, Hayakawa Y. Cytokines in cancer immunity and immunotherapy. Immunol Rev. 2004;202:275–93.
Majima T, Ichikura T, Chochi K, et al. Exploitation of interleukin–18 by gastric cancers for their growth and evasion of host immunity. Int J Cancer. 2006;118:388–95.
Sugasawa H, Ichikura T, Kinoshita M, et al. Gastric cancer cells exploit CD4 + cell-derived CCL5 for their growth and prevention of CD8 + cell-involved tumor elimination. Int J Cancer. 2008;122:2535–41.
Chochi K, Ichikura T, Kinoshita M, et al. Helicobacter pylori augments growth of gastric cancers via the lipopolysaccharide-toll-like receptor 4 pathway whereas its lipopolysaccharide attenuates antitumor activities of human mononuclear cells. Clin Cancer Res. 2008;14:2909–17.
Khuri SF, Henderson WG, DePalma RG, Mosca C, Healey NA, Kumbhani DJ. Determinants of long-term survival after major surgery and the adverse effect of postoperative complications. Ann Surg. 2005;242:326–41.
Aosasa S, Ono S, Mochizuki H, et al. Activation of monocytes and endothelial cells depends on the severity of surgical stress. World J Surg. 2000;24:10–16.
Mokart D, Capo C, Blache JL, Delpero JR, Houvenaeghel G, Martin C, et al. Early postoperative compensatory anti-inflammatory response syndrome is associated with septic complications after major surgical trauma in patients with cancer. Br J Surg. 2002;89:1450–6.
Tsujimoto H, Ono S, Majima T, et al. Differential toll-like receptor expression after ex vivo lipopolysaccharide exposure in patients with sepsis and following surgical stress. Clin Immunol. 2006;119:180–7.
Ramer-Quinn DS, Baker RA, Sanders VM. Activated T helper 1 and T helper 2 cells differentially express the beta–2-adrenergic receptor: a mechanism for selective modulation of T helper 1 cell cytokine production. J Immunol. 1997;159:4857–67.
Spolarics Z, Siddiqi M, Siegel JH, Garcia ZC, Stein DS, Denny T, et al. Depressed interleukin–12-producing activity by monocytes correlates with adverse clinical course and a shift toward Th2-type lymphocyte pattern in severely injured male trauma patients. Crit Care Med. 2003;31:1722–9.
Clerici M, Shearer GM, Clerici E. Cytokine dysregulation in invasive cervical carcinoma and other human neoplasias: time to consider the TH1/TH2 paradigm. J Natl Cancer Inst. 1998;90:261–3.
Moore KW, O’Garra A, de Waal Malefyt R, Vieira P, Mosmann TR. Interleukin–10. Annu Rev Immunol. 1993;11:165–90.
Beissert S, Hosoi J, Grabbe S, Asahina A, Granstein RD. IL-10 inhibits tumor antigen presentation by epidermal antigen-presenting cells. J Immunol. 1995;154:1280–6.
Majima T, Ichikura T, Seki S, Takayama E, Hiraide H, Mochizuki H. Interleukin-10 and interferon-gamma levels within the peritoneal cavity of patients with gastric cancer. J Surg Oncol. 2001;78:124–30.
Majima T, Ichikura T, Seki S, et al. The influence of interleukin–10 and interleukin-18 on interferon-gamma production by peritoneal exudate cells in patients with gastric carcinoma. Anticancer Res. 2002;22:1193–9.
Mynster T, Christensen IJ, Moesgaard F, Nielsen HJ. Effects of the combination of blood transfusion and postoperative infectious complications on prognosis after surgery for colorectal cancer Danish RANX05 Colorectal Cancer Study Group. Br J Surg 2000;87:1553–62.
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Tsujimoto, H., Ichikura, T., Ono, S. et al. Impact of Postoperative Infection on Long-Term Survival After Potentially Curative Resection for Gastric Cancer. Ann Surg Oncol 16, 311–318 (2009). https://doi.org/10.1245/s10434-008-0249-8
Received:
Revised:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1245/s10434-008-0249-8