Journal of Gastric Cancer

  • 제23권3호
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  • Pages.462-475
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  • 2023
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  • 2093-582X(pISSN)
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  • 2093-5641(eISSN)
대한위암학회 (The Korean Gastric Cancer Association)
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Complication After Gastrectomy for Gastric Cancer According to Hospital Volume: Based on Korean Gastric Cancer Association-Led Nationwide Survey Data

  • Sang-Ho Jeong (Department of Surgery, Gyeongsang National University College of Medicine and Gyeongsang National University Changwon Hospital) ;
  • Moon-Won Yoo (Department of Surgery, Asan Medical Center, University of Ulsan College of Medicine) ;
  • Miyeong Park (Department of Anesthesiology, Gyeongsang National University Changwon Hospital) ;
  • Kyung Won Seo (Department of Surgery, Kosin University Gospel Hospital) ;
  • Jae-Seok Min (Department of Surgery, Dongnam Institute of Radiological and Medical Sciences, Cancer Center) ;
  • Information Committee of the Korean Gastric Cancer Association (Korean Gastric Cancer Association)
  • 투고 : 2023.04.25
  • 심사 : 2023.07.03
  • 발행 : 2023.07.31
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초록

Purpose: This study aimed to analyze the incidence and risk factors of complications following gastric cancer surgery in Korea and to compare the correlation between hospital complications based on the annual number of gastrectomies performed. Materials and Methods: A retrospective analysis was conducted using data from 12,244 patients from 64 Korean institutions. Complications were classified using the Clavien-Dindo classification (CDC). Univariate and multivariate analyses were performed to identify the risk factors for severe complications. Results: Postoperative complications occurred in 14% of the patients, severe complications (CDC IIIa or higher) in 4.9%, and postoperative death in 0.2%. The study found that age, stage, American Society of Anesthesiologists (ASA) score, Eastern Cooperative Oncology Group (ECOG) score, hospital stay, approach methods, and extent of gastric resection showed statistically significant differences depending on hospital volumes (P<0.05). In the univariate analysis, patient age, comorbidity, ASA score, ECOG score, approach methods, extent of gastric resection, tumor-node-metastasis (TNM) stage, and hospital volume were significant risk factors for severe complications. However, only age, sex, ASA score, ECOG score, extent of gastric resection, and TNM stage were statistically significant in the multivariate analysis (P<0.05). Hospital volume was not a significant risk factor in the multivariate analysis (P=0.152). Conclusions: Hospital volume was not a significant risk factor for complications after gastric cancer surgery. The differences in the frequencies of complications based on hospital volumes may be attributed to larger hospitals treating patients with younger age, lower ASA scores, better general conditions, and earlier TNM stages.

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과제정보

This research was supported by the nationwide survey project of the Information Committee funded by the Korean Gastric Cancer Association (grant number: KGCA2022ICx).

참고문헌

  1. Sung H, Ferlay J, Siegel RL, Laversanne M, Soerjomataram I, Jemal A, et al. Global cancer statistics 2020: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries. CA Cancer J Clin 2021;71:209-249. https://doi.org/10.3322/caac.21660
  2. Hong S, Won YJ, Lee JJ, Jung KW, Kong HJ, Im JS, et al. Cancer statistics in Korea: incidence, mortality, survival, and prevalence in 2018. Cancer Res Treat 2021;53:301-315. https://doi.org/10.4143/crt.2021.291
  3. Park SH, Kang MJ, Yun EH, Jung KW. Epidemiology of gastric cancer in Korea: trends in incidence and survival based on Korea Central Cancer Registry Data (1999-2019). J Gastric Cancer 2022;22:160-168. https://doi.org/10.5230/jgc.2022.22.e21
  4. Information Committee of the Korean Gastric Cancer Association. Korean Gastric Cancer Association-led nationwide survey on surgically treated gastric cancers in 2019. J Gastric Cancer 2021;21:221-235. https://doi.org/10.5230/jgc.2021.21.e27
  5. Kim HW, Lee DH, Park HS. The impact of Gyeongbu High Speed Rail construction on regional economic growth. KSCE J Civ Eng 2013;17:1206-1212. https://doi.org/10.1007/s12205-013-0199-y
  6. Hannan EL, Radzyner M, Rubin D, Dougherty J, Brennan MF. The influence of hospital and surgeon volume on in-hospital mortality for colectomy, gastrectomy, and lung lobectomy in patients with cancer. Surgery 2002;131:6-15. https://doi.org/10.1067/msy.2002.120238
  7. Lin HC, Xirasagar S, Lee HC, Chai CY. Hospital volume and inpatient mortality after cancer-related gastrointestinal resections: the experience of an Asian country. Ann Surg Oncol 2006;13:1182-1188. https://doi.org/10.1245/s10434-006-9005-0
  8. Enzinger PC, Benedetti JK, Meyerhardt JA, McCoy S, Hundahl SA, Macdonald JS, et al. Impact of hospital volume on recurrence and survival after surgery for gastric cancer. Ann Surg 2007;245:426-434. https://doi.org/10.1097/01.sla.0000245469.35088.42
  9. Birkmeyer JD, Sun Y, Wong SL, Stukel TA. Hospital volume and late survival after cancer surgery. Ann Surg 2007;245:777-783. https://doi.org/10.1097/01.sla.0000252402.33814.dd
  10. Nomura E, Tsukuma H, Ajiki W, Oshima A. Population-based study of relationship between hospital surgical volume and 5-year survival of stomach cancer patients in Osaka, Japan. Cancer Sci 2003;94:998-1002. https://doi.org/10.1111/j.1349-7006.2003.tb01391.x
  11. Goodney PP, Stukel TA, Lucas FL, Finlayson EV, Birkmeyer JD. Hospital volume, length of stay, and readmission rates in high-risk surgery. Ann Surg 2003;238:161-167. https://doi.org/10.1097/01.SLA.0000081094.66659.c3
  12. Halm EA, Lee C, Chassin MR. Is volume related to outcome in health care? A systematic review and methodologic critique of the literature. Ann Intern Med 2002;137:511-520. https://doi.org/10.7326/0003-4819-137-6-200209170-00012
  13. Birkmeyer JD, Siewers AE, Finlayson EV, Stukel TA, Lucas FL, Batista I, et al. Hospital volume and surgical mortality in the United States. N Engl J Med 2002;346:1128-1137. https://doi.org/10.1056/NEJMsa012337
  14. Kim TH, Kim IH, Kang SJ, Choi M, Kim BH, Eom BW, et al. Korean practice guidelines for gastric cancer 2022: an evidence-based, multidisciplinary approach. J Gastric Cancer 2023;23:3-106. https://doi.org/10.5230/jgc.2023.23.e11
  15. Lee HH, Son SY, Lee JH, Kim MG, Hur H, Park DJ. Surgeon's experience overrides the effect of hospital volume for postoperative outcomes of laparoscopic surgery in gastric cancer: multi-institutional study. Ann Surg Oncol 2017;24:1010-1017. https://doi.org/10.1245/s10434-016-5672-7
  16. Kim PS, Lee KM, Han DS, Yoo MW, Han HS, Yang HK, et al. External validation of a gastric cancer nomogram derived from a large-volume center using dataset from a medium-volume center. J Gastric Cancer 2017;17:204-211. https://doi.org/10.5230/jgc.2017.17.e21
  17. Kim KY, Yoo MW, Han HS, Yun IJ, Lee KY. The results of gastric cancer surgery during the early stage of a training hospital. J Gastric Cancer 2008;8:244-249. https://doi.org/10.5230/jkgca.2008.8.4.244
  18. Information Committee of Korean Gastric Cancer Association. Korean Gastric Cancer Association nationwide survey on gastric cancer in 2014. J Gastric Cancer 2016;16:131-140. https://doi.org/10.5230/jgc.2016.16.3.131
  19. Bosman FT, Carneiro F, Hruban RH, Theise ND. WHO Classification of Tumours of the Digestive System. Geneva: World Health Organization, 2010. 
  20. Brierley J, Gospodarowicz M, Wittekind C. TNM Classification of Malignant Tumours. 8th ed. Hoboken (NJ):Wiley-Blackwell, 2017. 
  21. Dindo D, Demartines N, Clavien PA. Classification of surgical complications: a new proposal with evaluation in a cohort of 6336 patients and results of a survey. Ann Surg 2004;240:205-213. https://doi.org/10.1097/01.sla.0000133083.54934.ae
  22. An JY, Min JS, Hur H, Lee YJ, Cho GS, Park YK, et al. Laparoscopic sentinel node navigation surgery versus laparoscopic gastrectomy with lymph node dissection for early gastric cancer: short-term outcomes of a multicentre randomized controlled trial (SENORITA). Br J Surg 2020;107:1429-1439. https://doi.org/10.1002/bjs.11655
  23. Kim YW, Min JS, Yoon HM, An JY, Eom BW, Hur H, et al. Laparoscopic sentinel node navigation surgery for stomach preservation in patients with early gastric cancer: a randomized clinical trial. J Clin Oncol 2022;40:2342-2351.  https://doi.org/10.1200/JCO.21.02242
  24. An JY, Min JS, Lee YJ, Jeong SH, Hur H, Han SU, et al. Safety of laparoscopic sentinel basin dissection in patients with gastric cancer: an analysis from the SENORITA prospective multicenter quality control trial. J Gastric Cancer 2018;18:30-36. https://doi.org/10.5230/jgc.2018.18.e6
  25. Kanda M. Preoperative predictors of postoperative complications after gastric cancer resection. Surg Today 2020;50:3-11. https://doi.org/10.1007/s00595-019-01877-8
  26. Chen G, Wang J, Chen K, Kang M, Zhang H, Jin X, et al. Relationship between postoperative complications and the prognosis of gastric carcinoma patients who underwent surgical resection: a systematic review and meta-analysis. Cancer Contr 2021;28:10732748211011955.
  27. Kiuchi J, Komatsu S, Ichikawa D, Kosuga T, Okamoto K, Konishi H, et al. Putative risk factors for postoperative pneumonia which affects poor prognosis in patients with gastric cancer. Int J Clin Oncol 2016;21:920-926. https://doi.org/10.1007/s10147-016-0987-8
  28. Suzuki S, Kanaji S, Matsuda Y, Yamamoto M, Hasegawa H, Yamashita K, et al. Long-term impact of postoperative pneumonia after curative gastrectomy for elderly gastric cancer patients. Ann Gastroenterol Surg 2018;2:72-78. https://doi.org/10.1002/ags3.12037
  29. Visser A, Geboers B, Gouma DJ, Goslings JC, Ubbink DT. Predictors of surgical complications: a systematic review. Surgery 2015;158:58-65. https://doi.org/10.1016/j.surg.2015.01.012
  30. Shah N, Hamilton M. Clinical review: can we predict which patients are at risk of complications following surgery? Crit Care 2013;17:226.
  31. Ryo S, Kanda M, Ito S, Mochizuki Y, Teramoto H, Ishigure K, et al. The controlling nutritional status score serves as a predictor of short- and long-term outcomes for patients with stage 2 or 3 gastric cancer: analysis of a multi-institutional data set. Ann Surg Oncol 2019;26:456-464. https://doi.org/10.1245/s10434-018-07121-w
  32. Inokuchi M, Kato K, Sugita H, Otsuki S, Kojima K. Impact of comorbidities on postoperative complications in patients undergoing laparoscopy-assisted gastrectomy for gastric cancer. BMC Surg 2014;14:97.
  33. Chen HN, Chen XZ, Zhang WH, Yang K, Chen XL, Zhang B, et al. The impact of body mass index on the surgical outcomes of patients with gastric cancer: a 10-year, single-institution cohort study. Medicine (Baltimore) 2015;94:e1769.
  34. Kunisaki C, Makino H, Takagawa R, Sato K, Kawamata M, Kanazawa A, et al. Predictive factors for surgical complications of laparoscopy-assisted distal gastrectomy for gastric cancer. Surg Endosc 2009;23:2085-2093. https://doi.org/10.1007/s00464-008-0247-8
  35. Huang DD, Zhou CJ, Wang SL, Mao ST, Zhou XY, Lou N, et al. Impact of different sarcopenia stages on the postoperative outcomes after radical gastrectomy for gastric cancer. Surgery 2017;161:680-693. https://doi.org/10.1016/j.surg.2016.08.030
  36. Yoshikawa K, Shimada M, Kurita N, Iwata T, Nishioka M, Morimoto S, et al. Visceral fat area is superior to body mass index as a predictive factor for risk with laparoscopy-assisted gastrectomy for gastric cancer. Surg Endosc 2011;25:3825-3830. https://doi.org/10.1007/s00464-011-1798-7
  37. Lee HJ, Hyung WJ, Yang HK, Han SU, Park YK, An JY, et al. Short-term outcomes of a multicenter randomized controlled trial comparing laparoscopic distal gastrectomy with D2 lymphadenectomy to open distal gastrectomy for locally advanced gastric cancer (KLASS-02-RCT). Ann Surg 2019;270:983-991. https://doi.org/10.1097/SLA.0000000000003217
  38. Kim W, Kim HH, Han SU, Kim MC, Hyung WJ, Ryu SW, et al.; Decreased morbidity of laparoscopic distal gastrectomy compared with open distal gastrectomy for stage I gastric cancer: short-term outcomes from a multicenter randomized controlled trial (KLASS-01). Ann Surg 2016;263:28-35. https://doi.org/10.1097/SLA.0000000000001346
  39. Qi J, Zhang P, Wang Y, Chen H, Li Y. Does total gastrectomy provide better outcomes than distal subtotal gastrectomy for distal gastric cancer? A systematic review and meta-analysis. PLoS One 2016;11:e0165179.
  40. Liu Z, Feng F, Guo M, Liu S, Zheng G, Xu G, et al. Distal gastrectomy versus total gastrectomy for distal gastric cancer. Medicine (Baltimore) 2017;96:e6003.
  41. Li Z, Bai B, Xie F, Zhao Q. Distal versus total gastrectomy for middle and lower-third gastric cancer: a systematic review and meta-analysis. Int J Surg 2018;53:163-170. https://doi.org/10.1016/j.ijsu.2018.03.047