胃癌根治术后并发症(Clavien-Dindo分级)对患者远期生存的影响OA

Objective:To investigate the impact of early postoperative complications and the severity of Clavien-Dindo classifi-cation on long-term prognosis in patients after radical gastrectomy for gastric cancer.Methods:A retrospective cohort study combined with propensity score matching was conducted to collect the clinical data of 2720 patients who underwent radical gastrectomy between Jan.2004 and Dec.2018,including 1907 males and 813 females with a mean age of(56±10)years.Among them,1117 patients under-went laparoscopic surgery,1144 patients robotic surgery,365 patients open surgery,and 94 patients were converted to open surgery.Based on the occurrence of complications within 30 days after surgery,patients were divided into the complication group(n=331)and the non-complication group(n=2389).Complication severity was recorded based on the Clavien-Dindo classification system.The clini-copathological characteristics,intraoperative conditions,postoperative complications,and survival follow-up results were compared be-tween the two groups after propensity score matching,and the influencing factors of patient prognosis were analyzed.Survival curves were plotted,and survival analysis,univariate and multivariate analyses were performed.Results:After propensity score matching,1324 pa-tients were successfully matched(331 in the complication group,993 in the non-complication group).Baseline data such as age,gen-der,BMI,tumor diameter,pT stage,pN stage,pTNM stage,and ASA grade were well balanced between the two groups.After matching,the operation time and postoperative hospital stay in the complication group were longer,and the intraoperative blood loss was more than those in the non-complication group(P<0.05).No statistically significant differences were found in surgical approach,resection range,radicality,total number of dissected lymph nodes,total number of metastatic lymph node,or perioperative blood transfusion between the two groups(P>0.05).The median follow-up was 60 months.The 5-year overall survival(OS)rates of the non-complication group and the complication group were 67.5%and 55.0%,respectively(χ2=21.221,P<0.001),and the 5-year disease-free survival(DFS)rates were 66.3%and 46.5%,respectively(χ2=34.315,P<0.001).Subgroup analysis showed that compared with the non-complica-tion group,there were no statistically significant differences in 5-year OS and DFS in patients with mild complications(Clavien-Dindo gradeⅠ-Ⅱ,P>0.05),while the 5-year OS and DFS were significantly decreased in patients with severe complications(Clavien-Dindo grade Ⅲ-Ⅳ,P<0.001).In the subgroups of different pTNM stages(stageⅠ,Ⅱ,Ⅲ),severe complications were significantly associa-ted with worse OS and DFS(P<0.05).Multivariate Cox regression analysis identified severe complications as an independent risk fac-tor for reduced 5-year OS(HR=2.603,95%CI=2.035～3.329,P<0.001)and DFS(HR=3.016,95%CI=2.368～3.841,P<0.001)after radical gastrectomy for gastric cancer.Other independent risk factors included pTNM stage(stage Ⅱ,Ⅲ),age≥60 years,and total gastrectomy.BMI≥25.0 kg/m2(HR=0.755,95%CI=0.608～0.937,P<0.05)and robotic surgery(HR=0.693,95%CI=0.508～0.945,P=0.021)were independent protective factors for OS.Conclusions:Severe complications(Clavien-Dindo grades Ⅲ-Ⅳ)after radical gastrectomy for gastric cancer can significantly reduce patients' 5-year OS and DFS.Mild complications show no significant impact on long-term survival.Thorough preoperative assessment,meticulous intraoperative operation,and enhanced perioperative management to prevent severe complications are crucial for improving the long-term prognosis of patients.