Postoperative complications hurt survival after gastrectomy for gastric cancer

Postoperative complications (POCs) after gastrectomy for gastric cancer appear to worsen survival outcomes, reports a recent meta-analysis.

Accessing the databases of PubMed and Scopus, researchers retrieved 64 studies eligible for qualitative and quantitative analysis. All but five studies included patients that received different surgical treatments. Most of the studies were retrospective in design and conducted at a single centre. All were observational in nature and thus came with inherent selection bias and confounding.

The cumulative sample size was 46,198 gastric cancer patients, in whom the rate of POCs ranged from 1.88 percent to 59.8 percent, developing over median follow-up durations ranging from 18 to 149.9 months.

Pooled analysis of 25 studies showed that unspecific POCs had a significant negative impact on overall survival (OS; hazard ratio [HR], 1.58, 95 percent confidence interval [CI], 1.37–1.82; p=0.000). Moreover, major POCs likewise showed a statistically stronger impact on OS than minor complications (HR, 1.52, 95 percent CI, 1.23–1.88; p=0.000).

Infectious (HR, 1.46, 95 percent CI, 1.22–1.75; p=0.000), anastomotic (HR, 2.35, 95 percent CI, 1.68–3.29; p=0.000) and cardiopulmonary (HR, 1.61, 95 percent CI, 1.21–2.15; p=0.001) complications all significantly worsened OS.

Similarly, POCs correlated with poorer recurrence-free and cancer-specific survival.

“There is still a need to investigate the mechanisms by which POCs affect long-term survival, especially immunosuppression after gastrectomy in patients who unavoidably experienced POCs. This may be helpful in finding a method to reduce the effect of POCs,” researchers said.