{"title":"残胃癌根治性切除术后严重并发症的危险因素及预后意义:一项多中心回顾性研究。","authors":"Kensuke Kudou, Mitsuhiko Ota, Kippei Ogaki, Yasue Kimura, Yuta Kasagi, Naomichi Koga, Hirofumi Hasuda, Hirotada Tajiri, Tetsuro Kawazoe, Yasuo Tsuda, Tomonori Nakanoko, Koji Ando, Eiji Oki, Tomoharu Yoshizumi","doi":"10.1002/jso.70094","DOIUrl":null,"url":null,"abstract":"<p><strong>Background: </strong>Remnant gastric cancer (RGC) is associated with higher surgical difficulty and poorer long-term outcomes than primary gastric cancer. However, the impact of postoperative complications on prognosis in RGC remains unclear.</p><p><strong>Methods: </strong>This retrospective, multicenter cohort study included 126 patients who underwent curative surgery for RGC across five institutions between 2007 and 2024. Postoperative complications were evaluated using the Clavien-Dindo (CD) classification. Patients were stratified into two groups based on the presence of severe complications (CD grade ≥ 3a). Logistic regression analysis was used to identify risk factors for complications, and Cox proportional hazards models were applied to determine prognostic factors for overall survival (OS) and recurrence-free survival (RFS).</p><p><strong>Results: </strong>Severe postoperative complications occurred in 15.9% of patients. Multivariate analysis identified smoking (OR = 8.28, p = 0.0048), operative time ≥ 300 min (OR = 3.52, p = 0.0448), and blood transfusion (OR = 4.82, p = 0.0380) as independent risk factors for severe complications. Kaplan-Meier analysis demonstrated significantly poorer 5-year OS (32.0% vs. 65.6%, p = 0.002) and RFS (33.6% vs. 64.3%, p < 0.001) in patients with CD grade ≥ 3a complications. CD grade ≥ 3a and pathological Stage II or higher were independent prognostic factors for both OS and RFS.</p><p><strong>Conclusions: </strong>Severe postoperative complications are associated with poor long-term outcomes in patients undergoing curative surgery for RGC. Identifying and mitigating modifiable risk factors, such as smoking and operative invasiveness, may help improve surgical and oncological outcomes in this challenging population.</p>","PeriodicalId":17111,"journal":{"name":"Journal of Surgical Oncology","volume":" ","pages":""},"PeriodicalIF":1.9000,"publicationDate":"2025-09-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":"{\"title\":\"Risk Factors and Prognostic Significance of Severe Postoperative Complications After Curative Resection for Remnant Gastric Cancer: A Multicenter Retrospective Study.\",\"authors\":\"Kensuke Kudou, Mitsuhiko Ota, Kippei Ogaki, Yasue Kimura, Yuta Kasagi, Naomichi Koga, Hirofumi Hasuda, Hirotada Tajiri, Tetsuro Kawazoe, Yasuo Tsuda, Tomonori Nakanoko, Koji Ando, Eiji Oki, Tomoharu Yoshizumi\",\"doi\":\"10.1002/jso.70094\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<p><strong>Background: </strong>Remnant gastric cancer (RGC) is associated with higher surgical difficulty and poorer long-term outcomes than primary gastric cancer. However, the impact of postoperative complications on prognosis in RGC remains unclear.</p><p><strong>Methods: </strong>This retrospective, multicenter cohort study included 126 patients who underwent curative surgery for RGC across five institutions between 2007 and 2024. Postoperative complications were evaluated using the Clavien-Dindo (CD) classification. Patients were stratified into two groups based on the presence of severe complications (CD grade ≥ 3a). Logistic regression analysis was used to identify risk factors for complications, and Cox proportional hazards models were applied to determine prognostic factors for overall survival (OS) and recurrence-free survival (RFS).</p><p><strong>Results: </strong>Severe postoperative complications occurred in 15.9% of patients. Multivariate analysis identified smoking (OR = 8.28, p = 0.0048), operative time ≥ 300 min (OR = 3.52, p = 0.0448), and blood transfusion (OR = 4.82, p = 0.0380) as independent risk factors for severe complications. Kaplan-Meier analysis demonstrated significantly poorer 5-year OS (32.0% vs. 65.6%, p = 0.002) and RFS (33.6% vs. 64.3%, p < 0.001) in patients with CD grade ≥ 3a complications. CD grade ≥ 3a and pathological Stage II or higher were independent prognostic factors for both OS and RFS.</p><p><strong>Conclusions: </strong>Severe postoperative complications are associated with poor long-term outcomes in patients undergoing curative surgery for RGC. 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引用次数: 0
摘要
背景:残胃癌(RGC)与原发性胃癌相比,手术难度更高,远期预后较差。然而,RGC术后并发症对预后的影响尚不清楚。方法:这项回顾性、多中心队列研究纳入了2007年至2024年间5个机构为RGC接受根治性手术的126例患者。术后并发症采用Clavien-Dindo (CD)分类进行评估。根据是否存在严重并发症(CD等级≥3a)将患者分为两组。采用Logistic回归分析确定并发症的危险因素,采用Cox比例风险模型确定总生存期(OS)和无复发生存期(RFS)的预后因素。结果:术后严重并发症发生率为15.9%。多因素分析发现吸烟(OR = 8.28, p = 0.0048)、手术时间≥300 min (OR = 3.52, p = 0.0448)、输血(OR = 4.82, p = 0.0380)是严重并发症的独立危险因素。Kaplan-Meier分析显示5年OS (32.0% vs. 65.6%, p = 0.002)和RFS (33.6% vs. 64.3%)显著较差,p。结论:接受根治性RGC手术的患者,严重的术后并发症与较差的长期预后相关。识别和减轻可改变的危险因素,如吸烟和手术侵入性,可能有助于改善这一具有挑战性人群的手术和肿瘤预后。
Risk Factors and Prognostic Significance of Severe Postoperative Complications After Curative Resection for Remnant Gastric Cancer: A Multicenter Retrospective Study.
Background: Remnant gastric cancer (RGC) is associated with higher surgical difficulty and poorer long-term outcomes than primary gastric cancer. However, the impact of postoperative complications on prognosis in RGC remains unclear.
Methods: This retrospective, multicenter cohort study included 126 patients who underwent curative surgery for RGC across five institutions between 2007 and 2024. Postoperative complications were evaluated using the Clavien-Dindo (CD) classification. Patients were stratified into two groups based on the presence of severe complications (CD grade ≥ 3a). Logistic regression analysis was used to identify risk factors for complications, and Cox proportional hazards models were applied to determine prognostic factors for overall survival (OS) and recurrence-free survival (RFS).
Results: Severe postoperative complications occurred in 15.9% of patients. Multivariate analysis identified smoking (OR = 8.28, p = 0.0048), operative time ≥ 300 min (OR = 3.52, p = 0.0448), and blood transfusion (OR = 4.82, p = 0.0380) as independent risk factors for severe complications. Kaplan-Meier analysis demonstrated significantly poorer 5-year OS (32.0% vs. 65.6%, p = 0.002) and RFS (33.6% vs. 64.3%, p < 0.001) in patients with CD grade ≥ 3a complications. CD grade ≥ 3a and pathological Stage II or higher were independent prognostic factors for both OS and RFS.
Conclusions: Severe postoperative complications are associated with poor long-term outcomes in patients undergoing curative surgery for RGC. Identifying and mitigating modifiable risk factors, such as smoking and operative invasiveness, may help improve surgical and oncological outcomes in this challenging population.
期刊介绍:
The Journal of Surgical Oncology offers peer-reviewed, original papers in the field of surgical oncology and broadly related surgical sciences, including reports on experimental and laboratory studies. As an international journal, the editors encourage participation from leading surgeons around the world. The JSO is the representative journal for the World Federation of Surgical Oncology Societies. Publishing 16 issues in 2 volumes each year, the journal accepts Research Articles, in-depth Reviews of timely interest, Letters to the Editor, and invited Editorials. Guest Editors from the JSO Editorial Board oversee multiple special Seminars issues each year. These Seminars include multifaceted Reviews on a particular topic or current issue in surgical oncology, which are invited from experts in the field.