Which is a more reliable indicator of survival after gastric cancer surgery: Postoperative complication occurrence or C‐reactive protein elevation?

PurposeThe impact of postoperative complications on survival after radical surgery for esophageal, gastric, and colorectal cancers remains controversial. We conducted a systematic review of recent publications to examine the effect of postoperative complications on oncological outcome.MethodsA literature search of PubMed/MEDLINE was performed using the keywords “esophageal cancer,” “gastric cancer,” and “colorectal cancer,” obtaining 27 reports published online up until the end of April 2016. Articles focusing on (i) postoperative morbidity and oncological outcome; and (ii) body mass index (BMI), postoperative morbidity, and oncological outcome, were selected. Univariate and multivariate analyses (Cox proportional hazards model) were performed.ResultsPatients with postoperative complications had significantly poorer long‐term survival than those without complications. Complications were associated with impaired oncological outcomes. The hazard ratios for overall survival were 1.67 (95% confidence interval [CI], 1.31‐2.12), 1.59 (95% CI, 1.13‐2.24), and 1.55 (95% CI, 1.28‐1.87) in esophageal, gastric, and colorectal cancers, respectively. High BMI was associated with postoperative morbidity rate but not with poor oncological outcome. Low BMI was significantly associated with inferior oncological outcome.ConclusionsComplications after radical surgery for esophageal, gastric, and colorectal cancers are associated with patient prognosis. Avoiding such complications might improve the outcomes.

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“…However, some studies have found that postoperative complications do not always have a negative impact on prognosis 40, 41, 42. Migita et al .…”

Section: Resultsmentioning

confidence: 99%

“…Presently, these speculations have not been confirmed. Saito et al 42. suggested that the actual event that affects patient survival might not be postoperative complications, but excessive inflammation after surgery.…”

Section: Resultsmentioning

confidence: 99%

Does postoperative morbidity worsen the oncological outcome after radical surgery for gastrointestinal cancers? A systematic review of the literature

Shimada

Fukagawa

Haga

et al. 2017

Annals of Gastroent Surgery

104

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“…Surgery provides the only possibility of cure in patients with gastric cancer. Despite improvements in perioperative care and surgical procedures, postoperative complications remain a major impediment and threat to survival after gastric cancer surgery[1-3]. Therefore, it is crucial to specify a reliable and simple risk assessment index to indicate the possibility of postoperative complications, and the likelihood of early and safe patient discharge.…”

Section: Introductionmentioning

confidence: 99%

Postoperative decrease of serum albumin predicts short-term complications in patients undergoing gastric cancer resection

Liu¹,

Ge²,

Ai³

et al. 2017

WJG

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AIMTo find an accurate and simple predictor for postoperative short-term complications after gastrectomy.METHODSTwo hundred and twenty-three patients undergoing gastric cancer resection between October 1, 2015 and September 30, 2016 were enrolled in this study. Univariate and multivariate analyses were used to identify risk factors for complications after gastrectomy. The cutoff values and diagnostic accuracy were examined by receiver operating characteristic curves.RESULTSSixty-two (27.8%) patients had short-term complications after gastric cancer resection. The postoperative decrease in serum albumin (∆ALB) was an independent risk factor for complications (OR = 17.957, 95%CI: 6.073-53.095, P < 0.001). The cutoff value was 14.0% and the area under the curve was higher than that of C-reactive protein on postoperative day 3 (area under the curve: 0.806 vs 0.709). Patients with ∆ALB ≥ 14.0% were more likely to have short-term complications after gastrectomy (46.7% vs 5.0%, P < 0.001), prolonged hospital stay (17.2 ± 10.8 d vs 14.1 ± 4.2 d, P = 0.007) and higher comprehensive complication index (P < 0.001) than those with ∆ALB < 14.0%.CONCLUSIONPostoperative ∆ALB with a cutoff of 14.0% can be used to recognize patients who have high risk of short-term complications following gastric cancer resection.

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“…Moreover, it is also reported that patients receiving perioperative blood transfusions have significantly worse postoperative outcomes in pancreatic cancer patients and that the surgical stress, which is increased by prolonged operative times, correlates with the cancer prognosis, suggesting potential prognostic impacts of the early ligation [6][7][8][9] . To enjoy the clinical usefulness of early ligation, it is necessary that IPDA, one of the major afferent arteries, be identified during PD.…”

Section: Discussionmentioning

confidence: 99%

Distance from Left Renal Vein to Inferior Pancreaticoduodenal Artery: A Landmark for Identifying Inferior Pancreaticoduodenal Artery in Pancreatoduodenectomy

et al. 2017

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Background/Aim: During pancreatoduodenectomy, early ligation of major afferent arteries to pancreatic head prior to dissection of the corresponding veins may reduce intraoperative bleeding. Inferior pancreaticoduodenal artery (IPDA), one of the major afferent arteries, is difficult to identify. We measured the distance from left renal vein to IPDA based on preoperative multi-detector row computed tomography (MDCT) images for use as a new landmark for IPDA. Methods: The distance between left renal vein and IPDA was measured in 417 patients using MDCT images. Results: IPDA was identified on MDCT images in 415 out of the 417 patients (99.5%). The root of IPDA was located on cranial side of the root of left renal vein in 88 among the 415 patients (21.2%), and the distance was expressed as negative in these cases. The distance was 6.09 ± 7.46 mm. The distance when IPDA formed a common vessel with first jejunal artery (8.03 ± 6.74 mm; 323 cases, 77.8%) was significantly longer than when IPDA branched directly from superior mesenteric artery (SMA; -0.81 ± 5.74 mm; 62 cases, 15.0%) or posterior and anterior IPDAs branched separately from SMA (-2.04 ± 5.36 mm; 30 cases, 7.2%). Conclusions: The distance between left renal vein and IPDA can serve as a landmark for IPDA identification.

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Which is a more reliable indicator of survival after gastric cancer surgery: Postoperative complication occurrence or C‐reactive protein elevation?

Abstract: CRP elevation is a more reliable indicator of survival after gastric cancer surgery than postoperative complication occurrence. Surgeons should minimize the postoperative inflammatory response to improve prognosis.

Cited by 78 publications

References 51 publications

Does postoperative morbidity worsen the oncological outcome after radical surgery for gastrointestinal cancers? A systematic review of the literature

Does postoperative morbidity worsen the oncological outcome after radical surgery for gastrointestinal cancers? A systematic review of the literature

Postoperative decrease of serum albumin predicts short-term complications in patients undergoing gastric cancer resection

Distance from Left Renal Vein to Inferior Pancreaticoduodenal Artery: A Landmark for Identifying Inferior Pancreaticoduodenal Artery in Pancreatoduodenectomy

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