Intraoperative complications during gastrectomy for gastric cancer: incidence, treatment, and effect on postoperative complications and survival in a population-based nationwide study

Abstract

PURPOSE: Studies reporting intraoperative complications during gastrectomy for gastric cancer or their effect on short- and long-term outcomes are rare. Our aim was to examine the effect of major intraoperative complications to incidence of major postoperative complications and long-term survival after gastrectomy for gastric cancer. METHODS: This population-based, nationwide, and retrospective cohort study reports intraoperative complications and examines the effect of major intraoperative complications to incidence of major postoperative complications and mortality after gastrectomy for gastric cancer in Finland in 2005-2016. RESULTS: Total or partial gastrectomy was performed to 2,184 patients eligible for this study. A total of 552 (25.3%) intra-operative complications occurred in 483 patients. Major intraoperative complication occurred to 69 patients (3.2%) and major postoperative complication occurred to 374 patients (17.1%). The occurrence of major intraoperative complications was not associated to the risk of postoperative major complications in the crude (OR 1.13, CI 0.61-2.08) or in the adjusted analysis (OR 1.18, CI 0.62-2.27), compared to patients without major intraoperative complications. Major intraoperative complications were not associated to higher 90-day mortality (HR 1.76, 95% CI 0.81-3.82) or higher 5-year mortality (HR 1.09, 95% CI 0.79-1.52) compared to patients without major intraoperative complications. CONCLUSION: Intraoperative complications during gastric cancer surgery are common but mainly not life-threatening and can be managed with relatively low sequelae. Major intraoperative complications did not increase the risk of major postoperative complications and were not associated to higher 90-day, or 5-year mortality compared to patients without major intraoperative complications after gastric cancer surgery.