Kudou Kensuke, Ota Mitsuhiko, Ogaki Kippei, Kimura Yasue, Kasagi Yuta, Koga Naomichi, Hasuda Hirofumi, Tajiri Hirotada, Kawazoe Tetsuro, Tsuda Yasuo, Nakanoko Tomonori, Ando Koji, Oki Eiji, Yoshizumi Tomoharu
Department of Surgery and Science, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan.
Department of Surgery, Iizuka Hospital, Fukuoka, Japan.
J Surg Oncol. 2025 Nov;132(6):1155-1162. doi: 10.1002/jso.70094. Epub 2025 Sep 14.
Remnant gastric cancer (RGC) is associated with higher surgical difficulty and poorer long-term outcomes than primary gastric cancer. However, the impact of postoperative complications on prognosis in RGC remains unclear.
This retrospective, multicenter cohort study included 126 patients who underwent curative surgery for RGC across five institutions between 2007 and 2024. Postoperative complications were evaluated using the Clavien-Dindo (CD) classification. Patients were stratified into two groups based on the presence of severe complications (CD grade ≥ 3a). Logistic regression analysis was used to identify risk factors for complications, and Cox proportional hazards models were applied to determine prognostic factors for overall survival (OS) and recurrence-free survival (RFS).
Severe postoperative complications occurred in 15.9% of patients. Multivariate analysis identified smoking (OR = 8.28, p = 0.0048), operative time ≥ 300 min (OR = 3.52, p = 0.0448), and blood transfusion (OR = 4.82, p = 0.0380) as independent risk factors for severe complications. Kaplan-Meier analysis demonstrated significantly poorer 5-year OS (32.0% vs. 65.6%, p = 0.002) and RFS (33.6% vs. 64.3%, p < 0.001) in patients with CD grade ≥ 3a complications. CD grade ≥ 3a and pathological Stage II or higher were independent prognostic factors for both OS and RFS.
Severe postoperative complications are associated with poor long-term outcomes in patients undergoing curative surgery for RGC. Identifying and mitigating modifiable risk factors, such as smoking and operative invasiveness, may help improve surgical and oncological outcomes in this challenging population.
与原发性胃癌相比，残胃癌（RGC）的手术难度更高，长期预后更差。然而，术后并发症对RGC预后的影响仍不明确。
这项回顾性多中心队列研究纳入了2007年至2024年间在五个机构接受RGC根治性手术的126例患者。使用Clavien-Dindo（CD）分类评估术后并发症。根据严重并发症（CD分级≥3a）的存在将患者分为两组。采用逻辑回归分析确定并发症的危险因素，并应用Cox比例风险模型确定总生存期（OS）和无复发生存期（RFS）的预后因素。
15.9%的患者发生了严重术后并发症。多因素分析确定吸烟（OR = 8.28，p = 0.0048）、手术时间≥300分钟（OR = 3.52，p = 0.0448）和输血（OR = 4.82，p = 0.0380）为严重并发症的独立危险因素。Kaplan-Meier分析显示，CD分级≥3a并发症患者的5年OS（32.0%对65.6%，p = 0.002）和RFS（33.6%对64.3%，p < 0.001）明显更差。CD分级≥3a和病理分期II期或更高是OS和RFS的独立预后因素。
接受RGC根治性手术的患者发生严重术后并发症与长期预后不良相关。识别和减轻可改变的危险因素，如吸烟和手术侵袭性，可能有助于改善这一具有挑战性人群的手术和肿瘤学结局。
