Critical Perioperative Factors Influencing Postoperative Complications and Long-Term Survival in Patients with Gastric Cancer.

Abstract

Objective: We aimed to determine key perioperative factors affecting postoperative complications and long-term survival in gastric cancer patients undergoing gastrectomy and to evaluate their predictive value for clinical outcomes.

Methods: We conducted a retrospective analysis of clinical data from patients who underwent radical gastrectomy at our institution between January 2011 and December 2019. Logistic regression, along with univariate and multivariate analyses, and Kaplan-Meier survival curves were utilized to identify significant factors impacting postoperative morbidity and long-term survival.

Results: Patients were categorized into complication and noncomplication groups based on postoperative outcomes. Comparative analysis revealed significant associations between postoperative complications and the following variables: sex, hypertension, serum albumin (ALB) level, lactate dehydrogenase, prognostic nutritional index (PNI), α-fetoprotein (AFP), anastomotic method, laparoscopic versus open surgery and operative time (all P < .05). Multivariate logistic regression analysis indicated that laparoscopic versus open surgery, PNI, and hypertension were independent risk factors for postoperative complications. Kaplan-Meier survival analysis showed significant correlations between 3-year overall survival (OS) and age, PNI, ALB, carcinoembryonic antigen (CEA), carbohydrate antigen 19-9 (CA19-9), tumor diameter, TNM stage, lymphovascular invasion (LVI), perineural invasion, resection extent, and reconstruction method (all P < .05). Receiver operating characteristic curve analysis identified optimal cutoff values for 3-year OS prediction: PNI (area under the curve [AUC] = 0.709, cutoff = 41.55) and tumor diameter (AUC = 0.661, cutoff = 4.75 cm). Univariate and multivariate Cox regression analyses identified the following independent prognostic factors: LVI, advanced TNM stage, age, PNI, hypoalbuminemia, CEA, and CA19-9.

Conclusion: Laparoscopic surgery and adequate nutritional status are associated with a reduced incidence of postoperative complications. The PNI, LVI, TNM stage, ALB, CA19-9, age, and CEA were identified as independent perioperative risk factors for long-term survival in gastric cancer patients undergoing gastrectomy. The PNI is an independent factor influencing both short-term complications and long-term survival.