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Severity of Complications and Long-Term Survival After Laparoscopic Total Gastrectomy With D2 Lymph Node Dissection for Advanced Gastric Cancer: A Propensity Score-Matched Study

Background: Increasing numbers of studies have shown that postoperative complication is a negative predictor of long-term survival outcomes in in various malignancies. However, the impact of severity of complications on long-term survival for patients with gastric cancer still remains unclear. Aim: This study aimed to explore the relationship between the severity of complications and long-term survival outcomes after laparoscopic total gastrectomy (LTG) for advanced gastric cancer (AGC). Methods: The study analyzed 571 patients with AGC who underwent LTG in a single institution between April 2008 and June 2015. Patients were divided into 2 groups based on the occurrence or absence of postoperative complications which were recorded using the Clavien-Dindo (C-D) classification. Long-term survival outcomes were compared between groups in the propensity score-matched cohort. Results: The groups were well balanced after the propensity score matched. The complication (C) group was associated with decreased 5-year cancer-specific survival (CSS) (65.1% vs 76.2%, P = 0.049). Subgroup analysis showed that the severe complication (C-D grade > II) group was associated with decreased 5-year overall survival (OS) (46.3% vs 65.9%, P = 0.042) and cancer-specific survival (CSS) (53.7% vs 74.4%, P = 0.030). However, a comparative analysis of 5-year OS and CCS showed no significant differences between the minor complication (C-D grade II) group and matched NC group (68.9% vs 72.2%, P = 0.578; 75.6% vs 77.8%, P = 0.649; respectively). Multivariate analysis confirmed severe complication was an independent risk factor for decreased OS. Further analysis showed that older age, lower body mass index (BMI), and combined resection were independent risk factor for the occurrence of severe complications. Conclusion: Severe complications adversely affected long-term survival outcomes after LTG with D2 lymph node dissection for AGC. More attention should be paid to patients at high risk for severe complications in preoperative assessment and postoperative management.