Analysis Of Factors Associated With Complications And Their Impact On Postoperative Survival In Patients With Advanced Gastric Cancer Undergoing Radical Resection

Objective: Objective To explore the risk factors and influence on Postoperative complications(POCs)after radical gastric cancer resection in Advanced gastric cancer(AGC)patients.Methods: The clinicopathological data of patients with advanced gastric cancer who underwent radical gastrectomy in the Department of Gastrointestinal Surgery,Yijishan Hospital,Wannan Medical College from January 2015 to December 2017 were collected.Inclusion criteria :(1)Adenocarcinoma confirmed by gastroscopy and pathological biopsy;(2)The depth of tumor invasion was greater than that of Pt1;(3)No distant metastasis;(4)Radical resection(R0 resection)was performed;(5)No other malignant tumors were found preoperatively;(6)No emergency operation was performed;(7)No preoperative chemotherapy or radiotherapy.A total of 535 cases meeting the standard were included,and were divided into control group and case group according to the occurrence of postoperative complications,including 437 cases in the control group and 98 cases in the case group.Univariate analysis was performed for the two groups of data,and factors with P < 0.05 were included in the multivariate study for binary Logistic regression analysis to explore the independent predictors of postoperative complications.Complications were classified and recorded according to the Clavien-Dindo classification criteria.Clavien-Dindo grade I and above were considered to have complications and included in the case group;others were considered to have no complications and included in the control group.Severe complications(SC)were recorded as complications above grade II.Multiple complications occurred in a single patient,and only the most severe complications were recorded.With age,sex and BMI,preoperative albumin level,operation method,the range of resection,preoperative complications,abdominal surgery history,tumor diameter,p TNM stage,p T stage,p N staging and the postoperative adjuvant chemotherapy variable 1:1 Propensity score matching(Propensity score matching,PSM),the use of Kaplan Meier survival curve comparison Propensity score matching(PSM)of long-term survival after the queue.Results: There were 535 patients in the cohort,of whom 98 developed POCS and 437 did not.Univariate analysis showed that age,preoperative albumin,combined resection,comorbidities and PT staging were the risk factors for POCS.Further multivariate analysis showed that age,combined resection,and comorbidities were independent predictors of POCS.The 1;After 1PSM,there was no significant difference between the Complications(C)group(n = 92)and the non-complications(NC)group(n = 92).Survival analysis showed that 5-year overall survival(OS)was lower in group C(48.9% vs.62.0%,P = 0.040).Subgroup analysis showed that SC group(C-D>II)Compared with the matched NC group,overall survival was significantly lower(40.0% vs.62.0%,P = 0.008).Moreover,SC reduced OS compared with grade II complications(37.2% vs.59.2%,P = 0.023).However,another subgroup analysis showed only a negative tendency for grade II complications to affect patients’ OS compared with matched NC groups,but the difference was not statistically significant(54.4% vs.62.0%,P = 0.262).Further Cox risk regression showed that postoperative complications,tumor size,and adjuvant chemotherapy were independent predictors of adverse survival outcomes.Conclusion:Older age,combined organ resection and preoperative complications were independent predictors of POCS.POCS had a negative effect on postoperative survival,although the effect of grade II complications did not reach statistical significance.Adjuvant chemotherapy,tumor size,p TNM staging and POCS were independent predictors of poor patient survival outcomes.