Impact of Postoperative Complications on Clinical Outcomes After Gastrectomy for Cancer: Multicentre Study
Gastric cancer is one of the most common malignant tumors worldwide, and surgical resection (gastrectomy) is the primary treatment. Although the application of minimally invasive techniques has reduced surgical trauma, the incidence of postoperative complications after gastrectomy remains high, ranging from 20% to 40%. These complications not only affect patient recovery but also increase the burden on healthcare resources. Therefore, identifying and prioritizing complications that have the greatest impact on clinical outcomes is crucial for optimizing resource allocation and improving patient prognosis.
This study aims to assess the impact of specific complications on clinical outcomes after gastrectomy for gastric cancer, particularly on the escalation of care, reoperation, prolonged hospital stay, readmission, and 30-day mortality. Through a retrospective multicenter study, the authors hope to provide a reference for gastric cancer treatment globally and develop targeted improvement strategies for healthcare systems in different regions.
Source of the Paper
This paper was authored by Sander J. M. van Hootegem et al., with contributors from several internationally renowned medical institutions, including Erasmus Medical Centre (Netherlands), University Hospital Zürich (Switzerland), Seoul National University Cancer Hospital (South Korea), and others. The paper was published in 2025 in the British Journal of Surgery (BJS) under the title “Impact of postoperative complications on clinical outcomes after gastrectomy for cancer: multicentre study.”
Research Process
1. Study Design
This study is a retrospective multicenter analysis, including patients who underwent gastrectomy for gastric cancer between 2017 and 2021 across 43 centers in 16 countries. The primary objective was to evaluate the impact of postoperative complications on clinical outcomes, including escalation of care, reoperation, prolonged hospital stay, readmission, and 30-day mortality.
2. Study Population
A total of 7,829 patients were included, with 4,042 from East Asia and 3,787 from Europe/America. All patients had undergone gastrectomy for gastric cancer, excluding those who did not undergo Roux-en-Y or Billroth reconstruction or lymphadenectomy.
3. Definition of Complications
Complications were classified according to the KLASS trial and GastroData group criteria, including pulmonary complications, anastomotic leakage, abdominal collection, ileus, fistula, surgical site infection, cardiac complications, intra-abdominal bleeding, anastomotic stenosis, luminal bleeding, ischemia, and renal insufficiency.
4. Data Collection and Analysis
Data were sourced from the GastroBenchmark and GastroData databases, with multiple imputation used to address missing data. Adjusted relative risks (RR) and population attributable fractions (PAF) were calculated using Poisson regression models to assess the impact of specific complications on clinical outcomes.
Key Findings
1. Incidence of Complications
Among the 7,829 patients, 1,884 (24.1%) experienced postoperative complications. The most common complications were pulmonary complications (5.6%), anastomotic leakage (4.6%), and abdominal collection (3.8%).
2. Impact of Complications on Clinical Outcomes
- 30-Day Mortality: Anastomotic leakage, cardiac complications, and pulmonary complications had the greatest impact on 30-day mortality, with PAFs of 26.6%, 18.7%, and 15.6%, respectively.
- Escalation of Care: Anastomotic leakage and pulmonary complications had the greatest impact on escalation of care, with PAFs of 26.3% and 18.4%, respectively.
- Reoperation: Anastomotic leakage and intra-abdominal bleeding had the greatest impact on reoperation, with PAFs of 31.6% and 8.5%, respectively.
- Prolonged Hospital Stay: Most complications contributed to prolonged hospital stay, with anastomotic leakage and abdominal collection having the greatest impact.
- Readmission: The impact of complications on readmission was relatively small, with PAFs not exceeding 15.9%.
3. Regional Differences
Differences in the impact of complications were observed between East Asian and European/American patients. For example, pulmonary complications had a higher impact on escalation of care in East Asian patients (PAF 28.4%) compared to Western patients (PAF 14.2%).
Conclusion
This study demonstrates that anastomotic leakage and pulmonary complications have the greatest impact on clinical outcomes after gastrectomy for gastric cancer. Reducing the incidence of these complications would significantly lower 30-day mortality, escalation of care, and reoperation rates, thereby alleviating the healthcare burden. The findings provide important insights for global gastric cancer treatment and offer a basis for developing targeted improvement strategies for healthcare systems in different regions.
Highlights of the Study
- Multicenter Large-Sample Study: The study included 7,829 patients from 16 countries, providing broad representativeness.
- Population Attributable Fraction (PAF): The use of PAF to assess the impact of complications on clinical outcomes offers a scientific basis for prioritizing specific complications.
- Regional Difference Analysis: The study identified differences in the impact of complications between East Asian and European/American patients, providing a reference for tailored improvement strategies in different regions.
Additional Valuable Information
The study’s limitations include missing data and variations in the definition of complications across centers. Future research should further incorporate system- and organizational-level factors to provide a more comprehensive understanding of the occurrence and impact of complications.
Through this study, the authors have provided critical insights into the management of complications after gastrectomy for gastric cancer and offered scientific evidence for optimizing global gastric cancer treatment.