Risk Factors For Complications Of Total/Subtotal Gastrectomy For Gastric Cancer: Prospectively Collected, Based On The Clavien-Dindo Classification System

Background: Recent studies have analyzed risk factors associated with complications after gastric cancer surgery using the Clavien-Dindo classification (CD). However, they have been based on Asian population cohorts (Chinese, Japanese, Korean).Objectives: To prospectively analyze all post-gastrectomy complications according to severity using CD classification and identify postoperative risk factors and complications.Methods: We analyzed all gastrectomies for gastric cancer performed 2009-2014. Recorded parameters included demographic data, existing co-morbidities, neo-adjuvant treatment, intra-operative findings, postoperative course, and histologic findings. Postoperative complications were graded using CD classification.Results: The study comprised 112 patients who underwent gas trectomy. Mean age was 64.8 +/- 12.8 years; 53 patients (47.% underwent gastrectomy, 37 (34%) total gastrectomy ,11:an, 22 (19%) total extended gastrectomy. All patients had D2 lymphadenectomy. The average number of retrieved lymph nodes was 35 +/- 17. Severe complication rate (>= IIIa) was 14% and mortality rate was 1.8%. In a univariate analysis, age > 65 years; ASA 3 or higher; chronic renal failure; multi-organ resection; and tumor, node, and metastases (TNM) stage >= IIIc were found to be significantly associated with CD complication grade > III (P = 0.01, P = 0.05, P = 0.04, P = 0.04, and P = 0.01, respectively). Multivariate regression analysis revealed advanced stage (>= IIIc) and age > 65 years to be significant independent risk factors (P < 0.05).Conclusions: Age > 65 and advanced stage (>= IIIc) were the primary risk factors for complications of grade > III according to the CD classification following gastrectomy for gastric cancer.