scholarly journals Effects of Clavien-Dindo classification on long-term survival of patients with advanced gastric cancer after radical resection:A propensity score-matched study

2021 ◽  
Author(s):  
Wenwu Yan ◽  
Jun Du ◽  
Qingyi Li ◽  
Changsheng Yao ◽  
Mengxiang Zhu ◽  
...  
Keyword(s):  
Risk Factors ◽  
Gastric Cancer ◽  
Multivariate Analysis ◽  
Propensity Score ◽  
Radical Resection ◽  
Survival Outcomes ◽  
Term Survival ◽  
Long Term Survival ◽  
Independent Risk Factors

Abstract Background The impact of postoperative complications (POCs) classified by the Clavien-Dindo (C-D) system on long-term survival after radical resection in patients with advanced gastric cancer (AGC) is not yet clear.Methods This study analyzed 531 patients with AGC who underwent radical resection in an institution between January 2015 and December 2017. Patients were divided into two groups according to the occurrence of POCs and recorded according to C-D classifications.The long-term survival outcomes of the entire cohort after propensity score matching (PSM) were compared.Results After PSM, there was no significant difference in baseline data between the complications (C) group (n = 92) and the non-complications (NC) group (n = 92). Survival analysis showed that the 5-year overall survival (OS) and relapse-free survival (RFS) were lower in the C group (48.9% vs. 62.0%, p = 0.040; 38.5% vs. 54.9%, p = 0.005; respectively). Subgroup analysis showed that severe complications (C-D grade > II) were associated with a decrease in 5-year OS and RFS compared with the matched NC group (40.0% vs. 62.0%, p = 0.008; 29.4% vs. 54.9%, p = 0.001; respectively). Multivariate analysis confirmed adjuvant chemotherapy, tumor size, and complications were independent risk factors for poor survival outcomes. Further multivariate analysis showed that older age, combined excision, and comorbidities were independent risk factors for POCs.Conclusions Severe complications reduced the survival outcome of patients.Older age, combined excision, and comorbidities were independent risk factors for POCs. More attention should be paid to perioperative management of patients with high risk factors for complications.

scholarly journals Severity of Complications and Long-Term Survival After Laparoscopic Total Gastrectomy With D2 Lymph Node Dissection for Advanced Gastric Cancer: A Propensity Score-Matched Study

2018 ◽  
Vol 4 (Supplement 2) ◽  
pp. 223s-223s
Author(s):  
Z. Li
Keyword(s):  
Gastric Cancer ◽  
Propensity Score ◽  
Independent Risk Factor ◽  
Laparoscopic Total Gastrectomy ◽  
Survival Outcomes ◽  
Cancer Specific Survival ◽  
Term Survival ◽  
Long Term Survival ◽  
D2 Lymph Node Dissection

Background: Increasing numbers of studies have shown that postoperative complication is a negative predictor of long-term survival outcomes in in various malignancies. However, the impact of severity of complications on long-term survival for patients with gastric cancer still remains unclear. Aim: This study aimed to explore the relationship between the severity of complications and long-term survival outcomes after laparoscopic total gastrectomy (LTG) for advanced gastric cancer (AGC). Methods: The study analyzed 571 patients with AGC who underwent LTG in a single institution between April 2008 and June 2015. Patients were divided into 2 groups based on the occurrence or absence of postoperative complications which were recorded using the Clavien-Dindo (C-D) classification. Long-term survival outcomes were compared between groups in the propensity score-matched cohort. Results: The groups were well balanced after the propensity score matched. The complication (C) group was associated with decreased 5-year cancer-specific survival (CSS) (65.1% vs 76.2%, P = 0.049). Subgroup analysis showed that the severe complication (C-D grade > II) group was associated with decreased 5-year overall survival (OS) (46.3% vs 65.9%, P = 0.042) and cancer-specific survival (CSS) (53.7% vs 74.4%, P = 0.030). However, a comparative analysis of 5-year OS and CCS showed no significant differences between the minor complication (C-D grade II) group and matched NC group (68.9% vs 72.2%, P = 0.578; 75.6% vs 77.8%, P = 0.649; respectively). Multivariate analysis confirmed severe complication was an independent risk factor for decreased OS. Further analysis showed that older age, lower body mass index (BMI), and combined resection were independent risk factor for the occurrence of severe complications. Conclusion: Severe complications adversely affected long-term survival outcomes after LTG with D2 lymph node dissection for AGC. More attention should be paid to patients at high risk for severe complications in preoperative assessment and postoperative management.

scholarly journals Impact of postoperative complications on long-term survival of gastric cancer patients: results from a high-volume institution in China

2020 ◽  
Author(s):  
Hua-Yang Pang ◽  
Hui Wang ◽  
Lin-Yong Zhao ◽  
Xiao-Long Chen ◽  
Kai Liu ◽  
...  
Keyword(s):  
Risk Factors ◽  
Gastric Cancer ◽  
Prognostic Factor ◽  
Postoperative Complications ◽  
Pulmonary Infection ◽  
Independent Prognostic Factor ◽  
Term Survival ◽  
Long Term Survival ◽  
Independent Risk Factors

Abstract BackgroundThis study was aimed to evaluate the impact of postoperative complications (POCs) on long-term survival for gastric cancer (GC) patients with curative resection.MethodsFrom January 2009 to December 2014, a total of 1667 GC patients with curative gastrectomy were analyzed. Patients with any complications Clavien–Dindo (CD) grade II or higher were divided into complication group. Independent risk factors for the development of POCs and the relationship between POCs and long-term survival (excluding death within 90 days after surgery) were analyzed.ResultsOverall POCs CD ≥ 2 were diagnosed in 285 (17.10%) patients including infectious complications (ICs) in 231 (13.9%) and noninfectious complications (NICs) in 78 (4.68%) patients. Age ≥ 65 (P = 0.003), presence of comorbidity (P = 0.019), extensive lymphadenectomy (P = 0.027) and perioperative blood transfusion (P = 0.040) were independent risk factors of POCs. Multivariate analysis identified that presence of POCs (P < 0.001) was an independent prognostic factor and further analysis by complication type demonstrated that the deteriorated overall survival was mainly caused by ICs (P = 0.007) rather than NICs (P = 0.075), moreover, among all complications, pulmonary infection (P < 0.001) was the only significant prognostic factor.ConclusionPOCs may be an independent prognostic factor for long-term survival of GC patients and the risk is mainly driven by ICs, particular pulmonary infection.

Coagulopathy on the first postoperative day predicting the long-term survival of traumatic brain injury patients

2020 ◽  
Author(s):  
Wenxing Cui ◽  
Shunnan Ge ◽  
Yingwu Shi ◽  
Xun Wu ◽  
Jianing Luo ◽  
...  
Keyword(s):  
Risk Factors ◽  
Regression Analysis ◽  
Cox Regression ◽  
Term Survival ◽  
Long Term Survival ◽  
Cox Regression Analysis ◽  
Independent Risk Factors ◽  
The Relationship ◽  
Underlying Risk

Abstract Objective: The purpose of this study was to identify the relationship between coagulopathy during the perioperative period (before the operation and on the first day after the operation) and the long-term survival of TBI patients undergoing surgery, as well as to explore the predisposing risk factors that may cause perioperative coagulopathy.Methods: This retrospective study included 447 TBI patients who underwent surgery from January 1, 2015 to April 25, 2019. Clinical parameters, including patient demographic characteristics, biochemical tests, perioperative coagulation function tests (before the operation and on the first day after the operation) and intraoperative factors were collected. Log-rank univariate analysis and Cox regression models were conducted to assess the relationship between perioperative coagulopathy and the long-term survival of TBI patients. Furthermore, univariate and multivariate analyses were performed to identify the underlying risk factors for perioperative coagulopathy.Results: Multivariate Cox regression analysis identified age, AIS(head) = 5, GCS ≤ 8, systolic pressure at admission < 90 mmHg and postoperative coagulopathy (all P < 0.05) as independent risk factors for survival following TBI; we were the first to identify postoperative coagulopathy as an independent risk factor. According to multivariate logistic regression analysis, for the first time, abnormal ALT and RBC at admission, preoperative coagulopathy, infusion of colloidal solution > 1100 mL and intraoperative bleeding > 950 mL (all P < 0.005) were identified as independent risk factors for postoperative coagulation following surgery after TBI.Conclusions: Those who suffered from postoperative coagulopathy due to TBI had a higher hazard for poor prognosis than those who did not. Closer attention should be paid to postoperative coagulopathy and more emphasis should be placed on managing the underlying risk factors.

scholarly journals Radical Versus Non-Radical Resection for Small intestinal Gastrointestinal Stromal Tumors: A Propensity Score-Matched Analysis

2021 ◽  
Author(s):  
Linlin Yin ◽  
Haihao Yan ◽  
Jue Lin ◽  
Zuhong Ji ◽  
Guozhong Ji ◽  
...  
Keyword(s):  
Propensity Score ◽  
Gastrointestinal Stromal Tumors ◽  
Radical Surgery ◽  
Radical Resection ◽  
Term Survival ◽  
Long Term Survival ◽  
Resection Group ◽  
Stromal Tumors ◽  
Small Intestinal

Abstract Surgical resection is the first choice for the treatment of small intestinal gastrointestinal stromal tumors (GISTs), but the best surgical method for small intestinal stromal tumors remains undefined. It is not clear whether there is a difference in the long-term survival of small intestinal GISTs between radical surgery and non-radical surgery. We included 877 patients with small intestinal stromal tumors who underwent surgery between 2010 and 2015 from the SEER database. They were divided into the radical resection group and the non-radical resection group. To minimized the selection bias and mixed bias in the comparison, propensity score matching (PSM) and multivariate regression analysis were carried out. In the entire cohort, 120 patients underwent radical surgery and 757 patients received non-radical resection. The 1, 3, and 5-year OS rates were 95.7%, 80.2%, and 69.6% in the radical resection group versus 94.3%, 86.8%, and 77.2% in the non-radical resection group, respectively. (p=0.069) Meanwhile, radical resection had the similar CSS rates of 1, 3 and 5-year compared with non-radical surgery. (1-year CSS rate: 97.4% vs. 98.0%, 3-year CSS rate: 86.1% vs. 93.2%, 5-year CSS rate: 81.6% vs. 88.3%; p =0.056) Besides, after adjusting for other clinical factors and PSM, the long-term OS and CSS did not significantly differ between radical surgery and non-radical surgery. Our study preliminarily found that for small intestinal GISTs, there was no significant difference in long-term survival between radical surgery and non-radical surgery.

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