Postoperative complications and long-term survival after radical gastrectomy for gastric cancer: a real-world single-center study of 5 111 cases

Abstract:

Background and Aims Postoperative complications remain a major factor affecting both short-term recovery and long-term survival in patients undergoing radical gastrectomy for gastric cancer. However, large-scale real-world evidence regarding perioperative complications and prognosis after radical gastrectomy is still limited. This study aimed to investigate the incidence of postoperative complications, long-term survival outcomes, and their associated risk factors using a real-world single-center cohort.Methods A retrospective cohort study was conducted including patients who underwent radical gastrectomy for gastric cancer at Hunan Cancer Hospital between January 2011 and December 2023. Postoperative complications were evaluated according to the Clavien-Dindo classification, and grade Ⅱ or higher complications were defined as clinically significant events. Logistic regression analysis was used to identify independent risk factors for postoperative complications. Overall survival (OS) was estimated using the Kaplan-Meier method, and independent prognostic factors were analyzed using Cox proportional hazards regression models.Results A total of 5 111 patients were included, among whom 538 (10.53%) developed 693 events of postoperative complications of Clavien-Dindo grade Ⅱ or higher. The most common complications were pulmonary infection (3.1%), intra-abdominal infection (2.3%), pleural effusion (1.8%), intra-abdominal effusion (1.0%), and anastomotic leakage (0.9%). Perioperative mortality occurred in 30 patients (0.59%). Multivariate logistic regression analysis identified age ≥65 years, comorbidities, preoperative albumin <35 g/L, operative time ≥240 min, intraoperative blood loss ≥300 mL, open surgery, and total gastrectomy as independent risk factors for postoperative complications (all P<0.05). The estimated 5-year OS rate for the entire cohort was 62.5%. Multivariate Cox regression analysis demonstrated that age ≥65 years, low body mass index (BMI), total gastrectomy, perioperative blood transfusion, postoperative complications, and advanced pTNM stage were independent predictors of poor OS (all P<0.05).Conclusion The incidence of clinically significant postoperative complications after radical gastrectomy was 10.53%, and these complications were closely associated with patient condition, nutritional status, and surgical factors. Postoperative complications adversely affected not only perioperative safety but also long-term survival. Tumor pTNM stage remained the most important prognostic factor.