Surgical care quality and oncologic outcome after D2 gastrectomy for gastric cancer

Table 1 Baseline characteristics (n = 109)

Characteristic	n (%)
Male gender	51 (46.8)
Body mass index (kg/m2), mean (SD)	25.6 (4.9)
ASA score III-IV	67 (61.5)
Tumor site
Upper	21 (19.3)
Middle	43 (39.4)
Lower	38 (34.9)
All levels	7 (6.4)
UICC tumor stage
I	27 (24.8)
II	31 (28.4)
III	41 (37.6)
IV	10 (9.2)
Tumor type
Intestinal	50 (45.9)
Diffuse	56 (51.4)
Mixed	3 (2.8)
Lymph node invasion
No	45 (41.2)
Yes	64 (58.7)
Type of surgery
Total gastrectomy	103 (94.5)
Subtotal gastric resection	6 (5.5)
D2-lymph node dissection	109 (100)
Splenectomy	48 (44.0)
Cholecystectomy	19 (17.4)
Additional organ resection due to cancer invasion	10 (9.2)
Radicality
R0	104 (95.4)
Neoadjuvant/adjuvant treatment
No	69 (63.3)
Neoadjuvant chemoradiotherapy	2 (1.8)
Adjuvant chemotherapy	26 (23.9)
Adjuvant chemoradiotherapy	12 (11.0)

ASA: American Society of Anesthesiologists; UICC: Union for International Cancer Control.

Table 2 Univariate analyses of prognostic factors for five-year survival (n = 109)

Variables	OS			DSS
	Events/patients	HR (95%CI)	P value	Events/patients	HR (95%CI)	P value
Age (yr)			0.151			0.721
< 60	16/29	1		13/29	1
60-75	31/47	1.33 (0.73-2.44)		23/47	1.22 (0.62-2.42)
> 75	25/33	1.59 (0.85-2.97)		15/33	1.23 (0.54-2.79)
Sex			0.83			0.67
Male	34/51	1		26/51	1
Female	38/58	1.05 (0.66-1.67)		25/58	0.89 (0.51-1.54)
BMI (kg/m2)			0.02			0.01
< 25	43/56	1		33/56	1
> 25	29/53	0.56 (0.35-0.90)		18/53	0.47 (0.27-0.84)
ASA			0.61			0.43
I-II	25/42	1		22/42	1
III-IV	47/67	1.13 (0.70-1.85)		29/67	0.80 (0.46-1.39)
Operation type			0.05			0.041
D2	27/51	1		20/51	1
D2 + splenectomy	38/48	1.59 (0.97-2.61)		24/48	1.44 (0.81-2.56)
D2 + adjacent organ resection	7/10	1.80 (0.78-4.16)		7/10	3.67 (1.25-10.80)
Radicality			0.02			< 0.01
R0	67/104	1		46/104	1
R1	5/5	3.18 (1.24-8.14)		5/5	4.43 (1.69-11.59)
Neoadjuvant/adjuvant therapy			0.021			< 0.011
No	41/69	1		20/69	1
Neoadjuvant	1/2	0.75 (0.10-5.48)		1/2	1.53 (0.21-11.40)
Adjuvant	30/38	1.82 (1.13-2.93)		30/38	3.55 (2.01-6.28)
Tumor site			0.071			< 0.011
Upper third	14/21	1		8/21	1
Middle third	26/43	0.91 (0.48-1.75)		15/43	0.95 (0.40-2.25)
Lower third	25/38	1.04 (0.54-2.01)		21/38	1.54 (0.68-3.48)
All levels	7/7	2.87 (1.14-7.21)		7/7	4.74 (1.70-13.23)
Tumor stage			< 0.011			0.031
I	13/38	1		4/38	1
II	19/27	2.98 (1.47-6.05)		12/27	5.96 (1.92-18.50)
III	31/34	5.99 (3.09-11.62)		26/34	15.34 (5.30-44.38)
IV	9/10	10.15 (4.18-24.66)		9/10	30.67 (9.17-102.65)
Lauren classification			0.66			0.03
Intestinal	34/50	1		18/50	1
Diffuse2	38/59	1.11 (0.66-1.77)		33/59	1.87 (1.05-3.33)
Lymph node invasion						< 0.01
No	20/45	1		9/45	1
Yes	52/64	2.90 (1.72-4.89)		42/64	4.95 (2.40-10.23)
Lymph node ratio (%)			< 0.011			< 0.01
0	20/45	1		9/45	1
1-9	9/15	1.88 (0.85-4.14)		7/15	3.03 (1.12-8.16)
10-25	16/20	2.69 (1.37-5.28)		12/20	4.11 (1.70-9.95)
> 25	27/29	3.74 (2.09-6.70)		23/29	7.00 (3.22-15.20)

¹P for linearity;

²Three mixed type tumors included. ASA: American Society of Anesthesiologists; BMI: Body mass index; DSS: Disease-specific survival; HR: Hazard ratio; OS: Overall survival.

Table 3 Parameters reflecting the quality of care (n = 109)

Parameter	Value
Duration of surgery (min)	230 (200-255)
Operative blood loss (mL)	500 (300-900)
Hospital stay (d)	10 (8-12)
Number of lymph nodes studied	19 (11-25)
30-d mortality	2 (1.8)
30-d morbidity1	29 (26.6)
General morbidity
Cardiac	1 (0.9)
Pleural effusion	8 (7.3)
Pneumonia	3 (1.8)
Pleural empyema	1 (0.9)
Urinary tract infection	2 (1.8)
Thromboembolism	1 (0.9)
Cerebral infarction	1 (0.9)
Surgical morbidity
Bleeding	1 (0.9)
Anastomotic leak2	3 (2.8)
Abdominal abscess	7 (6.4)
Wound infection	1 (0.9)
Common bile duct injury	1 (0.9)
Bowel obstruction	1 (0.9)
Dindo-Clavien classification[32], severe morbidity	9 (8.3)
Grade III	3 (2.8)
Grade IV	3 (2.8)
Grade V	3 (2.8)

¹Figures are not additive because some patients had > 1 complication;

²Two of these were treated conservatively. Data are presented as median (IQR) or n (%).