Prognostic impacts of categorized postoperative complications in surgery for gastric cancer

Nagata, T.; Adachi, Yuki; Taniguchi, Akihiro; Kimura, Yu; Iitaka, Daisuke; Iwata, George; Yamaoka, Nobuki

doi:10.1016/j.asjsur.2022.05.087

Cited by 11 publications

(8 citation statements)

References 38 publications

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“…In a cohort study of 488 Japanese patients with endoscopic submucosal dissection (ESD) for GC after a 5-year follow-up, Tanoue et al showed that patients with severe comorbidities, defined by the ASA-PS classification, had significantly shorter survival than their counterparts with nonsevere comorbidities (5-year OS rate, 79.1 vs. 87.7%; P < 0.01); furthermore, severe comorbidities were significantly associated with a 2.56-fold increased mortality risk after adjustment for confounders [ 24 ]. Consistent findings were confirmed by another three Japanese cohort studies [ 12 , 20 , 29 ], and an inverse association of high-risk comorbidity with the prognosis was observed, with a nearly 8-fold increased risk of mortality, even after adjustment for confounders in both elderly and nonelderly patients [ 20 ]. Likely, Cao et al, using a hospital-based cohort of 639 Chinese elderly patients with early gastric adenocarcinoma (EGAC), found an impaired 5-year OS and increased hazard of mortality risk in elderly patients who had CCI ≥ 2 when compared to their counterparts with CCI < 2 (79.7% compared to 94.4%) [ 25 ], which was in agreement with results from another Chinese cohort study [ 30 ], supporting that the presence of comorbidities is a clinically significant prognostic factor of overall survival.…”

Section: Discussionsupporting

confidence: 76%

Association of high-risk comorbidity with overall survival among patients with gastric cancer and its sex-specific differences in China: a retrospective observational cohort study

Wu,

Tian,

et al. 2023

BMC Cancer

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Background Concomitant diseases often occur in cancer patients and are important in decision-making regarding treatments. However, information regarding the prognostic relevance of comorbidities for mortality risk is still limited among Chinese gastric cancer (GC) patients. This study aimed to investigate the association between comorbidities and 3-year mortality risk. Methods This retrospective study enrolled 376 GC patients undergoing radical gastrectomy at the Affiliated Zhongshan Hospital of Dalian University from January 2011 to December 2019. Demographic and clinicopathological information and treatment outcomes were collected. Patients were divided into low-, moderate- and high-risk comorbidity groups based on their Charlson Comorbidity Index (CCI) and age-adjusted CCI (ACCI) scores. Kaplan-Meier survival and Cox regression analyses were used to examine 3-year overall survival (OS) and mortality risk for each group. Results The median follow-up time was 43.5 months, and 40.2% (151/376) of GC patients had died at the last follow-up. There were significant differences in OS rates between ACCI-based comorbidity groups (76.56; 64.51; 54.55%, log-rank P = 0.011) but not between CCI-based comorbidity groups (log-rank P = 0.16). The high-risk comorbidity group based on the ACCI remained a significant prognostic factor for 3-year OS in multivariate analysis, with an increased mortality risk (hazard ratio [HR], 1.99; 95% CI, 1.15–3.44). Subgroup analysis revealed that this pattern only held for male GC patients but not for female patients. Conclusion The present study suggested that high-risk comorbidities were significantly associated with a higher mortality risk, particularly in Chinese male GC patients. Moreover, the ACCI score was an independent prognostic factor of long-term mortality.

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Section: Discussionsupporting

confidence: 76%

Association of high-risk comorbidity with overall survival among patients with gastric cancer and its sex-specific differences in China: a retrospective observational cohort study

Wu,

Tian,

et al. 2023

BMC Cancer

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“…Currently, ACCI is applied to standardize the evaluation of surgical patients and to predict the post-operative mortality of patients undergoing surgery (Asano et al, 2017;González Quevedo et al, 2017). Moreover, ACCI played a remarkable role in predicting post-surgical complications such as arrhythmia, delirium, stroke, and other diseases in the orthopedic surgery (Marya et al, 2016;Amit and Marya, 2022), and the incidence and severity of post-operative complications were higher in patients with high ACCI score than those with low ACCI score (Nagata et al, 2021). Nonetheless, the direct relationship between ACCI and POD in thoracic and abdominal surgery remains obscure to date.…”

Section: Introductionmentioning

confidence: 99%

The Age-adjusted Charlson Comorbidity Index predicts post-operative delirium in the elderly following thoracic and abdominal surgery: A prospective observational cohort study

Liu

et al. 2022

Front. Aging Neurosci.

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BackgroundPost-operative delirium (POD) presents as a serious neuropsychiatric syndrome in the elderly undergoing thoracic and abdominal surgery, which is mostly associated with poor prognosis. The Age-adjusted Charlson Comorbidity Index (ACCI) has been widely recognized as an independently predictive factor for overall survival rate and mortality in various surgeries. However, no studies demonstrated the potential relationship between ACCI and POD. The current study was to explore the correlation between ACCI and POD, and determine the predictive effect of ACCI on POD in the elderly after thoracic and abdominal surgery.Materials and methodsTotal 184 patients (≥60 years) who underwent thoracic and abdominal surgery from 2021.10 to 2022.5 were enrolled in this prospective observational cohort study. ACCI was calculated by weighting comorbidities and age. POD was diagnosed using Confusion Assessment Method (CAM) twice a day in the first 3 days after surgery. The Visual Analog Scale (VAS) was applied to measure pre-operative and post-operative pain at rest and in motion. All demographic and perioperative data were compared in patients with POD and without POD. ACCI and other variables were analyzed by univariate and multivariate logistic regression analysis. The characteristic curve of receiver operating characteristic (ROC) was used to further evaluate the accuracy of ACCI to predict POD.ResultsPost-operative delirium was diagnosed in 36 of 184 patients included in our study. The prevalence of POD in the elderly after thoracic and abdominal surgery was 19.6%. The outcomes by multivariate regression analysis showed the independent risk factors for POD were ACCI (OR: 1.834; 95%CI: 1.434–2.344; P < 0.001), pre-operative Mini-Mental State Examination (MMSE) scores (OR: 0.873; 95%CI: 0.767–0.994; P = 0.040), serum albumin (OR: 0.909; 95%CI: 0.826–1.000; P = 0.049) and pain scores in the post-operative third day (OR: 2.013; 95%CI: 1.459–2.778; P < 0.001). ACCI can predict POD more accurately with the largest area under curve (AUC) of 0.794 and sensitivity of 0.861, respectively.ConclusionAge-adjusted Charlson Comorbidity Index, pre-operative MMSE scores, serum albumin and post-operative pain were independently associated with POD in geriatric patients following thoracic and abdominal surgery. Moreover, ACCI may become an accurate indicator to predict POD early.

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“…The relationship between AL and long-term results after surgery for esophageal cancer is still controversial. Similar analyses of data from patients undergoing gastric surgery for cancer concluded that AL is associated with worse long-term DFS and OS (18,38) and suggested a closer follow up to promptly identify recurrence patients (39). In 2019, we investigated the possible correlation between recurrence and AL after surgery for carcinoma of the distal esophagus and gastroesophageal junction by analyzing data from 7 case series (17).…”

Section: Discussionmentioning

confidence: 97%

Overall Survival Following Anastomotic Leakage After Surgery for Carcinoma of the Esophagus and Gastroesophageal Junction: A Systematic Review

Pace

Minervini

Goglia

et al. 2023

In Vivo

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The effect of anastomotic leakage, in patients who underwent surgery for carcinoma of the esophagus and gastroesophageal junction, on overall survival (OS) is a debated and controversial topic. The aim of this systematic review was to clarify the impact of anastomotic leakage on long-term survival of patients with esophageal cancer undergoing esophagectomy. A systematic literature review was carried out from 2000 to 2022. We chose articles reporting data from patients who underwent surgery for carcinoma of the esophagus and gastroesophageal junction. Data regarding 1-, 3-and 5-year OS were analyzed. Twenty studies met the inclusion criteria, yielding a total of 9,279 patients. Analyzing data from selected studies, anastomotic leakage was found to be associated with decreased OS in 5,456 cases while in the remaining 3,823 it had no impact on long term survival (p<0.05). However, this result did not emerge from the other studies considered in the systematic review. Anastomotic leakage is a severe postoperative complication, which seems to have an impact on overall survival. However, the topic remains debated and not supported by all case series included in this systematic review.Esophageal cancer is the seventh most common cancer in the world and the sixth in mortality overall (544,000 deaths) in 2020 (1). Approximately 70% of cases occur in men, and there is a 2-to 3-fold difference in incidence and mortality rates between the sexes worldwide (1). Despite improvements in secondary and tertiary prevention, it still remains among the cancers with the highest death rate, with a 5-year survival rate of approximately 20% (2).Two are the main histological subtypes of esophageal cancer: esophageal adenocarcinoma (EAC) and esophageal squamous cell carcinoma (ESCC) (3). In addition, ESCC accounts for >85% of all esophageal cancer cases and it represents the most frequent histology in Asia and the incidence of EAC (4), especially in Western populations, has increased significantly. The increased incidence of EAC appears to be due to a birth cohort effect (for example, generational changes in prevalence of obesity), and this trend is expected to remain stable in highincome countries until 2030 (5).Surgery remains the treatment of choice for prolonged survival, the cornerstone of any potential cure and it is integrated in multimodal therapy, especially for advanced disease (6). Esophagectomy is a technically demanding procedure that is still associated with major complications and except in specialized centers, mortality and morbidity 1423

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Prognostic impacts of categorized postoperative complications in surgery for gastric cancer

Cited by 11 publications

References 38 publications

Association of high-risk comorbidity with overall survival among patients with gastric cancer and its sex-specific differences in China: a retrospective observational cohort study

Association of high-risk comorbidity with overall survival among patients with gastric cancer and its sex-specific differences in China: a retrospective observational cohort study

The Age-adjusted Charlson Comorbidity Index predicts post-operative delirium in the elderly following thoracic and abdominal surgery: A prospective observational cohort study

Overall Survival Following Anastomotic Leakage After Surgery for Carcinoma of the Esophagus and Gastroesophageal Junction: A Systematic Review

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