Effect of complication grade on survival following curative gastrectomy for carcinoma

AIM: To elucidate the potential impact of the grade of complications on long-term survival of gastric cancer patients after curative surgery.METHODS: A total of 751 gastric cancer patients who underwent curative gastrectomy between January 2002 and December 2006 in our center were enrolled in this study. Patients were divided into four groups: no complications, Grade Ⅰ, Grade Ⅱ and Grade Ⅲ complications, according to the following classification systems: T92(Toronto 1992 or Clavien), Accordion Classification, and Revised Accordion Classification. Clinicopathological features were compared amongthe four groups and potential prognostic factors were analyzed. The Log-rank test was used to assess statistical differences between the groups. Independent prognostic factors were identified using the Cox proportional hazards regression model. Stratified analysis was used to investigate the impact of complications of each grade on survival.RESULTS: Significant differences were found among the four groups in age, sex, other diseases(including hypertension, diabetes and chronic obstructive pulmonary disease), body mass index(BMI), intraoperative blood loss, tumor location, extranodal metastasis, lymph node metastasis, tumor-node-metastasis(TNM) stage, and chemotherapy. Overall survival(OS) was significantly influenced by the complication grade. The 5-year OS rates were 43.0%, 42.5%, 25.5% and 9.6% for no complications, and GradeⅠ, Grade Ⅱ and Grade Ⅲ complications, respectively(P < 0.001). Age, tumor size, intraoperative blood loss, lymph node metastasis, TNM stage and complication grade were independent prognostic factors in multivariate analysis. With stratified analysis, lymph node metastasis, tumor size, and intraoperative blood loss were independent prognostic factors for Grade Ⅰ complications(P < 0.001, P = 0.031, P = 0.030). Age and lymph node metastasis were found to be independent prognostic factors for OS of gastric cancer patients with Grade Ⅱ complications(P = 0.034, P = 0.001). Intraoperative blood loss, TNM stage, and chemotherapy were independent prognostic factors for OS of gastric cancer patients with Grade Ⅲ complications(P = 0.003, P = 0.005, P < 0.001). There were significant differences among patients with GradeⅠ, Grade Ⅱ and Grade Ⅲ complications in TNM stage Ⅱ and Ⅲ cancer(P < 0.001, P = 0.001).CONCLUSION: Complication grade may be an independent prognostic factor for gastric cancer following curative resection. Treatment of complica