Introduction Postoperative mortality (POM) within 30 days of oesophago-gastric resection remains significant and should be minimised to provide maximal chance of long-term survival. This study identifies factors predictive of 30-day POM in a large national multicentre cohort.
Methods A retrospective analysis was performed of 2670 patients (mean age 64±13 years) who underwent resection of junctional or gastric adenocarcinomas from 1997 to 2010 in 19 French centres. Ordinal data were compared using either the χ2 test or Mann–Whitney U test, as appropriate. A stepwise logistic regression model was built to identify by multivariate analysis variables independently predictive of 30-day POM.
Results This study included 1893 men and 777 females, with a mean patient age of 64.2±13 years. 774 patients (29.0%) had a junctional, Siewert I or Siewert II type tumour and 1896 patients (71.0%) had either a Siewert type III or gastric adenocarcinoma. The majority of patients (2045, 76.6%) underwent gastrectomy, 625 (23.4%) oesophagectomy and proximal gastrectomy and 209 (7.8%) total oesophagogastrectomy. Resection was R0 in 2224 patients (83.3%). Neoadjuvant treatment was given to 665 patients (24.5%). A total of 114 patients died within 30 days of surgery (4.3%). POM rates increased during three study periods (1997–2000, 3.3%; 2001–2005, 3.6%; 2006–2010, 5.6%; p=0.021). The POM rate was significantly higher in patients who experienced grade III and IV toxicity during neoadjuvant chemotherapy when compared to those who did not (8.7% vs 2.6% respectively, p=0.007). Patients ≥60 years old and American Society of Anaesthesiology grade III or IV correlated with POM (p=0.002 and p=0.000, respectively). Variables indicating advanced disease consistently predicted POM (metastases at diagnosis, p=0.005; disease requiring extended resection, p=0.005; surgery with palliative intent, p 8 resections/annum (OR 0.389, 95% CI 0.157 to 0.965, p=0.042) and no grade III or IV toxicity during neoadjuvant treatment (OR 0.286, 95% CI 0.107 to 0.762, p=0.012) were protective factors.
Conclusion This large national cohort study confirms patients with advanced disease are at higher risk of POM and centralisation of oesophago-gastric cancer resection is warranted. The novel finding that poor tolerance of neoadjuvant therapy increases the POM rate has significant implications for decision making in this subgroup of patients (Clinical Trial.gov identifier NCT01249859).
Competing interests None declared.
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