Prognostic significance of postoperative complication after curative resection for patients with gastric cancer

Purposes: To investigate the impact of postoperative complication on long-term survival in gastric cancer patients after curative resection. Methods: A total 663 gastric cancer patients undergoing potentially curative resection during January 2010 to November 2014 were studied. Complications were classified according to the Clavien-Dindo severity classification. Results: Postoperative complications occurred in 138 of 663 cases (20.8%). Multivariate analysis identified >65 years old (P = 0.001), male (P = 0.035), and total gastrectomy (P = 0.037) as independent risk factors for postoperative complications. The 5-year overall survival rate was 48.7% in the no complication group, which was significantly better than that in the complication group (42.7%, P = 0.01). Further stratified analysis by cancer staging revealed that decline in 5-year overall survival due to postoperative complication existed among stage I (P = 0.032), II (P = 0.041), and III (P = 0.001) patients. Cox proportional hazards model showed that increasing pT (P = 0.013) and pN (P = 0.001) grade, advanced pTNM (P = 0.001) stage, total gastrectomy (P = 0.001), and postoperative complication (P = 0.006) were independent prognostic factors. Conclusion: Postoperative complications have a significant negative impact on the long-term survival in gastric cancer patients even if the tumor is resected curatively.