In-hospital complications after gastrectomy in relation to long-term survival in gastric adenocarcinoma: a...

It remains unclear whether post-operative complications reduce the long-term survival following gastrectomy for gastric cancer, despite research on the subject. We aimed to help fill this knowledge gap in a study that took the main methodological concerns of the existing literature into account.

This nationwide population-based cohort study included patients who underwent gastrectomy for gastric adenocarcinoma in Sweden between 2006 and 2020, with follow-up until 2024. Data came from medical records and national health data registries. The exposure was in-hospital complications defined by the Clavien-Dindo classification, categorized into three groups: no complications, mild complications (grade I-II), and severe complications (grade IIIa-IVb). The outcomes were all-cause and disease-specific mortality between 91 days and 5 years following gastrectomy. Multivariable Cox regression provided hazard ratios (HR) with 95 % confidence intervals (CI), adjusted for age, sex, education, comorbidity, neoadjuvant chemotherapy, extent of the gastrectomy (total or subtotal), microscopically radical surgery, and pathological tumor stage.

The study included 2448 patients. Compared to patients without complications (n = 1381), those with severe complications (n = 443, 18 %) had an adjusted HR of 1.16 (95 % CI 1.00-1.34) for all-cause mortality and HR of 1.22 (95 % CI 1.05-1.42) for disease-specific mortality. Patients with mild complications (n = 573, 23 %) had no statistically significantly increased risk of mortality outcomes (HR 1.04 [95 % CI 0.91-1.19] for all-cause mortality and HR 1.07 [95 % CI 0.93-1.24] for disease-specific mortality).

Severe in-hospital complications might increase the risk of 5-year mortality following gastric cancer surgery also after excluding death during the initial 90 days of surgery.