Analysis Of Risk Factors Of Perioperative Complications In Patients With Radical Gastrectomy For Gastric Cancer And Its Influence On Prognosis

AIM To study the gastric cancer radical therapy in patients with gastric cancer risk factors for perioperative complications and its influence on prognosis.Methods Retrospective collection of Tianjin Medical University Affiliated Tumor Hospital between January 2009 and August 2011 lines of 1148 cases of gastric cancer patients with radical gastrectomy the clinical,pathological and follow-up data,using Pearsonc2 test and Logistic regression analysis to analyses the risk factors of perioperative complications in patients with radical gastrectomy,COX regression analysis of perioperative complications influence on prognosis,Kaplan Meier-survival curve drawing method.Results1.Of the 1148 patients,male 851 cases,female 297 cases,age range 19~89(average59.9 years);perioperative complications 312 cases(27.2%),including 140 cases of pulmonary infection,53 cases of abdominal infection.2.Multiariable Logistic regression analysis showed that age more than 65 years old(OR: 0.736,95%CI: 0.558~0.971,p =0.030),Serum Albumin was less than 35g/L(OR: 2.626,95%CI: 1.479~4.665,p =0.001),Borrmann type IV(OR: 0.748,95%CI: 0.610~0.917,p =0.005),tumor site was 1/3 on the stomach(OR: 1.326,95%CI: 1.167~1.506,p =0.000),Combined multi-visceral resection(OR: 0.624,95%CI: 0.428~0.0.909,p =0.014)were independent risk factors of perioperative complications for patients with radical gastrectomy;3.65 years of age or older(OR: 0.534,95%CI: 0.370~0.769,p =0.001),Tumor was located superior 1/3 part of stomach(OR: 1.702,95%CI: 1.433~2.021,p =0.000),intraoperative chemotherapy does not(OR: 1.655,95%CI: 1.141~2.401,p =0.008)were independent risk factors for perioperative pulmonary infection;4.Borrmann type IV(OR: 0.576,95%CI: 0.369~0.900,p =0.015),intraoperative chemotherapy(OR: 0.431,95%CI: 0.230~0.810,p =0.009),intraoperative blood loss was greater than 400 ml(OR: 0.411,95%CI: 0.176~0.959,p =0.040)and combined organ resection(OR: 0.412,95%CI: 0.215~0.789,p =0.008)were independent risk factors for perioperative intraperitoneal infection.5.A total of 614 patients(53.5%)were followed up completely after operation.The follow-up time was 1.0 ~ 81.0 months(median 35.0)months.The results of multivariate COX regression analysis showed that age,intraoperative chemotherapy,TNM-staging,the number of lymph node metastases,positive soft tissue outside lymph nodes and Clavien-Dindo complication grade were independent risk factors for prognosis of patients with gastric cancer after radical resection(all p < 0.05).6.The median survival time of patients with complications of III grade or above during perioperative period and those with complications below III grade(including no complications)were 16.0 and 40.0 months,respectively.The 5-year overall survival rate was 25.3% and 40.9,respectively.There was significant difference between the two groups(p < 0.05).Conclusion1.The risk of perioperative complications would be higher if the patient had these characteristics: age ? 65,preoperative serum albumin levels lower than 35 g / L,tumors located at 1 / 3 of the stomach,Borrmann IV and intraoperative combined organ excision.2.Patients with age ? 65,tumors located 1 / 3 upper of the stomach,without intraoperative chemotherapy had a higher risk of perioperative lung infection.3.Patients with Borrmann IV,intraoperative chemotherapy,intraoperative bleeding? 400 ml and combined organ resection had a higher risk of perioperative abdominal infection.4.The prognosis of patients undergoing radical gastrectomy with severe complications during perioperative period is poor.For patients undergoing radical gastrectomy,the survival rate of patients with Clavien-Dindo grade III or above in perioperative period was significantly lower than that in patients without perioperative complications and with complications below Clavien-Dindo grade III.