Negative Impact of Leakage on Survival of Patients Undergoing Curative Resection for Advanced Gastric Cancer

Background and Objectives: Leakage has been shown to adversely affect survival in patients undergoing surgery for gastrointestinal malignancies. However, the effect of leakage following radical gastrectomy in patients with gastric cancer remains unclear. Methods: In total, 478 patients with advanced gastric cancer who underwent surgery with curative intent were reviewed. Anastomosis or duodenal stump leakage was diagnosed clinically or radiologically. Risk factors for leakage were evaluated by univariate and multivariate analyses. The impact of leakage on patient survival was analyzed using the Kaplan-Meier method. Results: Leakage was diagnosed in 32 of 478 patients (6.7%); 14 patients (2.9%) exhibited esophagojejunal anastomotic leakage, 14 (2.9%) showed duodenal stump leakage, and four (0.8%) showed gastroduodenal anastomotic leakage. Poor performance status [ odds ratio (OR): 4.01, 95% confidence interval (CI): 1.80-8.93] and tumor location (OR: 3.74, 95% CI: 1.56-8.89) were risk factors for postoperative leakage. Overall mean survival of patients with leakage was significantly lower than that of patients without leakage (30.5 vs. 96.2 months; P < 0.001). Leakage was one of the independent predictive factor for overall survival [ hazard ratio (HR): 3.58, 95% CI: 2.29-5.59]. Conclusions: Postoperative inflammation due to leakage is a negative prognostic factor for patients with advanced gastric cancer. J. Surg. Oncol. 2011;104:734-740. (C) 2011 Wiley Periodicals, Inc.