Relationship Between Postoperative Complications and the Prognosis of Gastric Carcinoma Patients Who Underwent Surgical Resection: A Systematic Review and Meta-Analysis

• Published in: Cancer control Vol. 28; p. 10732748211011955
• Main Authors: Chen, Guofeng, Wang, Jun, Chen, Kaibo, Kang, Muxing, Zhang, Hang, Jin, Xiaoli, Lin, Lele, Chen, Jian
• Format: Journal Article
• Language: English
• Published: Los Angeles, CA SAGE Publications 01.01.2021; Sage Publications Ltd; SAGE Publishing
• Subjects: Anastomotic leak; Anastomotic Leak - etiology; Cancer; Complications; Gastrectomy - adverse effects; Gastric cancer; Humans; Medical prognosis; Meta-analysis; Pneumonia; Pneumonia - etiology; Postoperative; Postoperative Complications - etiology; Prognosis; Risk Factors; Stomach Neoplasms - pathology; Stomach Neoplasms - surgery; Survival; Wound Infection - etiology; postoperative complications; postoperative pneumonia; gastric carcinoma; prognosis; anastomotic leakage; survival
• ISSN: 1073-2748; 1526-2359; 1526-2359; 1073-2748
• DOI: 10.1177/10732748211011955

Background: Whether the presence of postoperative complications was associated with poor prognosis of gastric carcinoma (GC) patients remain controversial. This meta-analysis was designed and reported to compare the survival difference between patients with complications and non-complications. Methods: Cochrane Library, PubMed and Embase databases were comprehensively searched for published literatures to review current evidence on this topic. The survival data were extracted, and a random-effect or fixed-effect model was used to analyze the correlation between postoperative complications and oncologic outcome of GC patients. Results: Of all studies identified, 32 were eligible for this pooled analysis, with a total of 32,067 GC patients. The incidence of postoperative complications was approximately 12.5% to 51.0%. Among them, infectious complications varied from 3.0% to 28.6%, anastomotic leakage varied from 1.1% to 8.7% and postoperative pneumonia varied from 1.6% to 12.8%. The presence of postoperative complications resulted in a significant poorer overall survival (OS) of gastric carcinoma patients (hazard ratio [HR]:1.49, 95% confidence interval [CI]: 1.33-1.67, P < 0.001). Additionally, the pooled results showed a significant correlation between infectious complications and decreased OS (HR: 1.61, 95%CI: 1.38-1.88, P < 0.001). Concerning specific postoperative complications, we found that both anastomotic leakage (HR: 2.36, 95%CI: 1.62-3.42, P < 0.001) and postoperative pneumonia (HR: 1.74, 95%CI: 1.22-2.49, P = 0.002) impaired the OS of gastric carcinoma patients. Conclusion: Postoperative complications were significantly correlated to recurrence and poor survival in gastric carcinoma patients. To gain a better surgical outcome and long-term oncological outcome, postoperative complications should be minimized as much as possible.