Risk factors associated with complication following gastrectomy for gastric cancer : Prospective analysis based on the Clavien-Dindo system

Abstract

Introduction: The Clavien-Dindo classification has been advocated as being superior to the current classification system of postoperative complications which does not take into consideration the severity of complications. The purpose of this study was to analyze all postgastrectomy complications and to identify risk factors related to postoperative complications. Methods: Complication data was collected prospectively through weekly conferences with all gastric adenocarcinoma patients who underwent gastrectomy between March 2011 and February 2012 at Seoul National University Hospital. Complications were categorized according to the Clavien-Dindo classification. Results: Out of the 881 patients who underwent gastrectomy, 197 (22.4%) had complications with 254 events (28.8%). The numbers of grade I, II, IIIa, IIIb, IVa, and V complications according to the Clavien-Dindo classification, were 71 (8.1%), 58 (6.6%), 108 (12.3%), 8 (0.9%), 5 (0.6%), and 4 (0.5%), respectively. Total gastrectomy (OR, 2.14

95% CI, 1.40-3.28, p<0.001), combined resection (OR, 1.99

95% CI, 1.30-3.05, p=0.002), and age of 60 years or more (OR, 1.69

95% C.I., 1.20-2.39, p=0.003) were found to be significant independent risk factors for overall complications of gastrectomy. ASA score 3 or 4(OR, 3.67

95% CI, 1.52-8.89, p=0.004) and moderate or severe malnutrition (OR, 1.76

95% C.I., 1.01-3.08, p=0.047) with total gastrectomy, combined resection and age of 60 years or more were significant risk factors for systemic complications Conclusions: Prospective collection and systemic categorization of complication data may be useful for identifying clinical events and defining meaningful complications. Extensive gastric cancer surgery in old age may increase the risk of postoperative complications.