胃癌腹腔镜胃切除术后并发症的风险因素及其对生存率的影响

IF 2.9 4区医学 Q2 GASTROENTEROLOGY & HEPATOLOGY Annals of Gastroenterological Surgery Pub Date : 2024-02-24 DOI:10.1002/ags3.12780

Vo Duy Long, Dang Quang Thong, Tran Quang Dat, Doan Thuy Nguyen, Nguyen Viet Hai, Ho Le Minh Quoc, Nguyen Vu Tuan Anh, Nguyen Lam Vuong, Nguyen Hoang Bac

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引用次数: 0

摘要

腹腔镜胃切除术（LG）治疗胃癌（GC）后，术后并发症与长期生存之间的关系仍不确定。本研究旨在确定术后并发症的发生率和风险因素，并评估其对接受腹腔镜胃切除术患者生存结果的影响。本研究对2015年3月至2021年12月期间接受腹腔镜胃切除术治疗胃腺癌的621名患者进行了回顾性研究。术后并发症根据Clavien-Dindo分类法进行分类，主要并发症定义为III级或以上。采用逐步回归的逻辑回归模型来确定并发症的风险因素。为评估术后并发症对生存率的影响，对总生存率（OS）和无病生存率（DFS）采用了单变量和多变量考克斯比例危险模型。术后并发症的总发生率为17.6%（109例患者）；33例患者（5.3%）出现了主要并发症。主要并发症的独立风险因素是Charlson合并症指数（OR[95% CI]，1.87 [1.09-3.12]，每增加1分，P值=0.018）和吻合类型（OR[95% CI]，0.28 [0.09-0.91]，比较Billroth II和Billroth I，P值=0.029）。多变量分析发现，主要并发症是降低 OS（HR [95% CI]，2.32 [1.02-5.30]，p 值 = 0.045）和 DFS（HR [95% CI]，2.63 [1.37-5.06]，p 值 = 0.004）的独立预后因素。导致生存率下降的其他预后因素包括肿瘤大小、有无浸润性淋巴结和T4a分期。Charlson合并症指数和吻合类型被认为是术后主要并发症的风险因素。主要并发症被证明对生存结果有不利影响。

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Risk factors of postoperative complications and their effect on survival after laparoscopic gastrectomy for gastric cancer

Background

The association between postoperative complications and long-term survival after laparoscopic gastrectomy (LG) for gastric cancer (GC) remains uncertain. This study aimed to determine the incidence and risk factors of postoperative complications and evaluate their impact on survival outcomes in patients undergoing LG.

Methods

A retrospective study was conducted on 621 patients who underwent LG for gastric adenocarcinoma between March 2015 and December 2021. Postoperative complications were classified according to the Clavien–Dindo classification, with major complications defined as Grade III or higher. Logistic regression models with stepwise backward procedure were used to identify risk factors for complications. To assess the impact of postoperative complications on survival, uni- and multi-variable Cox proportional hazard models were used for overall survival (OS) and disease-free survival (DFS).

Results

Overall rate of postoperative complications was 17.6% (109 patients); 33 patients (5.3%) had major complications. Independent risk factors for major complications were Charlson comorbidities index (OR [95% CI], 1.87 [1.09–3.12], p-value = 0.018 for each one score increase), and type of anastomosis (OR [95% CI], 0.28 [0.09–0.91], p-value = 0.029 when comparing Billroth II with Billroth I). Multivariable analysis identified major complications as an independent prognostic factor to reduce OS (HR [95% CI], 2.32 [1.02–5.30], p-value = 0.045) and DFS (HR [95% CI], 2.63 [1.37–5.06], p-value = 0.004). Other prognostic factors for decreased survival outcomes were tumor size, presence of invasive lymph nodes, and T4a stage.

Conclusions

Major complications rate of LG for GC was approximately 5.3%. Charlson comorbidities index and type of anastomosis were identified as risk factors for major postoperative complications. Major complications were demonstrated to pose adverse impact on survival outcomes.

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