Work

In-hospital complications after gastrectomy in relation to long-term survival in gastric adenocarcinoma: a population-based cohort study

Year: 2025

Type: article

Abstract: BACKGROUND: 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. METHODS: 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. RESULTS: 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). CONCLUSION: 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.

Source: European Journal of Surgical Oncology

DOI: 10.1016/j.ejso.2025.111367

Authors: I. Ernudd, F. Mattsson, W. Leijonmarck, A. Sonden, J. Asplund, J. Lagergren