Impact of postoperative complications on gastric cancer survival

Long-term implications of postoperative complications, particularly non-cancer-related mortality in patients with gastric cancer following gastrectomy, remain unclear. We aimed to evaluate the impact of these complications on non-cancer-related deaths.

A cohort of 236 patients who underwent curative gastrectomy for gastric cancer in a Japanese hospital was divided based on complications classified as Clavien-Dindo grade II or higher. The Kaplan-Meier method, log-rank tests, and Cox hazard ratio analysis were used to evaluate recurrence-free survival and overall survival and to identify complications and survival predictors.

Delirium was the most common complication (21 of 52 patients). A significant difference was observed in the overall survival (with complications, 3-year: 58.1% and 5-year: 51.6%; without complications, 3-year: 82.3% and 5-year: 73.6%; P < .001) but not in recurrence-free survival (with complications, 3-year: 77.8% and 5-year: 77.8%; without complications, 3-year: 87.5% and 5-year: 85.2%). Non-cancer-related deaths, predominantly resulting from pneumonia, were more prevalent in the complications group than in the noncomplications group. Factors, including high American Society of Anesthesiologists Physical Status scores, blood transfusion, open surgery, male sex, total gastrectomy, and a history of neurologic/psychiatric disease, were independently associated with decreased overall survival.

Postoperative complications affect long-term prognosis, resulting in decreased overall survival and increased noncancer mortality. Proactive strategies, including optimizing preoperative management, preventing complications, and postdischarge interventions, are essential, with a focus on pulmonary disease prevention to improve prognosis after gastrectomy.