Department of Surgery, Xijing Hospital of Digestive Diseases, The Fourth Military Medical University, No. 127 Changle West Road, Xian 710032, China.
Department of Surgery, Xijing Hospital of Digestive Diseases, The Fourth Military Medical University, No. 127 Changle West Road, Xian 710032, China.
Int J Surg. 2018 Jun;54(Pt A):62-69. doi: 10.1016/j.ijsu.2018.04.034. Epub 2018 Apr 23.
Increasing numbers of studies have shown that postoperative complication is a negative predictor of long-term survival outcomes in various malignancies. However, the impact of severity of complications on long-term survival for patients with gastric cancer still remains unclear. This study aimed to explore the relationship between the severity of complications and long-term survival outcomes after laparoscopic total gastrectomy (LTG) for advanced gastric cancer (AGC).
The study analyzed 571 patients with AGC who underwent LTG in a single institution between April 2008 and June 2015. Patients were divided into two groups based on the occurrence or absence of postoperative complications which were recorded using the Clavien-Dindo (C-D) classification. Long-term survival outcomes were compared between groups in the propensity score-matched cohort.
The groups were well balanced after the propensity score matched. The complication (C) group was associated with decreased 5-year cancer-specific survival (CSS) (65.1% vs. 76.2%, P=0.049). Subgroup analysis showed that the severe complication (C-D grade > II) group was associated with decreased 5-year overall survival (OS) (46.3% vs. 65.9%, P = 0.042) and cancer-specific survival (CSS) (53.7% vs. 74.4%, P = 0.030). However, a comparative analysis of 5-year OS and CCS showed no significant differences between the minor complication (C-D grade II) group and matched NC group (68.9% vs. 72.2%, P = 0.578; 75.6% vs. 77.8%, P = 0.649; respectively). Multivariate analysis confirmed severe complication was an independent risk factor for decreased OS. Further analysis showed that older age, lower body mass index (BMI), and combined resection were independent risk factor for the occurrence of severe complications.
Severe complications adversely affected long-term survival outcomes after LTG with D2 lymph node dissection for AGC. More attention should be paid to patients at high risk for severe complications in preoperative assessment and postoperative management.
越来越多的研究表明，术后并发症是各种恶性肿瘤长期生存结局的负面预测因素。然而，胃癌患者并发症严重程度对长期生存的影响仍不清楚。本研究旨在探讨腹腔镜全胃切除术（LTG）治疗进展期胃癌（AGC）后并发症严重程度与长期生存结局的关系。
本研究分析了 2008 年 4 月至 2015 年 6 月在单机构接受 LTG 的 571 例 AGC 患者。根据术后并发症的发生与否，采用 Clavien-Dindo（C-D）分类将患者分为两组。在倾向评分匹配队列中比较两组的长期生存结局。
经倾向评分匹配后，两组平衡良好。并发症（C）组 5 年癌症特异性生存率（CSS）降低（65.1% vs. 76.2%，P=0.049）。亚组分析显示，严重并发症（C-D 分级> II 级）组 5 年总生存率（OS）降低（46.3% vs. 65.9%，P=0.042）和癌症特异性生存率（CSS）降低（53.7% vs. 74.4%，P=0.030）。然而，对 5 年 OS 和 CSS 的比较分析显示，轻度并发症（C-D 分级 II 级）组与匹配的 NC 组之间无显著差异（68.9% vs. 72.2%，P=0.578；75.6% vs. 77.8%，P=0.649）。多变量分析证实严重并发症是 OS 降低的独立危险因素。进一步分析显示，年龄较大、体重指数（BMI）较低和联合切除术是严重并发症发生的独立危险因素。
严重并发症对接受 D2 淋巴结清扫的 LTG 治疗 AGC 的患者长期生存结局产生不利影响。在术前评估和术后管理中，应更加关注严重并发症高危患者。
