Early reoperations after gastrectomy: impact on morbidity, mortality, and long-term oncologic outcomes

Gastrectomy is central to the curative treatment of gastric cancer but carries substantial postoperative risks. Early reoperations represent severe complications, yet their impact on long-term oncologic outcomes remains unclear. Understanding this relationship is crucial for optimizing cancer care and patient counseling.

We conducted a retrospective cohort study of 466 patients who underwent gastrectomy for gastric adenocarcinoma between 2012 and 2022 at a tertiary center. Early reoperation was defined as any unplanned return to the operating room during the initial hospitalization or within 90 days of discharge from the hospital. The primary aim was to evaluate the impact of early reoperation on long-term oncologic outcomes, specifically overall survival (OS) and disease-free survival. Secondary outcomes included perioperative morbidity, mortality, and factors influencing the delivery of adjuvant therapy. Survival outcomes were assessed using Kaplan-Meier analysis and multivariate Cox regression.

Among 466 patients, 48 (10.3%) required early reoperation, most commonly owing to anastomotic leaks or bleeding. Although these patients exhibited significantly worse short-term outcomes, including higher rates of major complications (100% vs 6.2%; P <.001), intensive care unit admission (62.5% vs 23.9%; P <.001), 90-day mortality (14.9% vs 2.2%; P <.001), and reduced resumption of chemotherapy (24.4% vs 39.6%; P =.047), the primary oncologic endpoint analysis revealed that reoperation was not independently associated with OS (hazard ratio [HR], 1.115; 95% CI, 0.711-1.751; P =.635) or disease recurrence (HR, 0.805; 95% CI, 0.453-1.432; P =.461). Independent predictors of poorer long-term outcomes included postoperative infection, poor tumor differentiation, and advanced stage.

Early reoperation has a significant impact on perioperative outcomes but does not independently affect long-term oncologic prognosis. Tumor biology and infectious complications are the primary drivers of survival and recurrence. These findings suggest that patients requiring early reoperation should not be considered to have compromised long-term cancer outcomes solely based on the need for surgical reintervention, emphasizing the importance of preventing major complications while maintaining focus on optimal oncologic care.