Gian Luca Baiocchi1, Simone Giacopuzzi2, Daniel Reim3, Guillaume Piessen4, Paulo Matos da Costa5, John V Reynolds6, Hans-Joachim Meyer7, Paolo Morgagni8, Ines Gockel9, Lucio Lara Santos10, Lone Susanne Jensen11, Thomas Murphy12, Domenico D'Ugo13, Riccardo Rosati14, Uberto Fumagalli Romario15, Maurizio Degiuli16, Wojciech Kielan17, Stefan Mönig18, Piotr Kołodziejczyk19, Wojciech Polkowski20, Manuel Pera21, Paul M Schneider22, Bas Wijnhoven23, Wobbe O de Steur24, Suzanne S Gisbertz25, Henk Hartgrink24, Johanna W van Sandick26, Maristella Botticini27, Arnulf H Hölscher28, William Allum29, Giovanni De Manzoni2. 1. Department of Clinical and Experimental Sciences, Surgical Clinic, University of Brescia, and 3rd Division of General Surgery, Spedali Civili di Brescia, Brescia, Italy. 2. Department of Surgery, General and Upper G.I. Surgery Division, University of Verona, Verona, Italy. 3. Surgical Department, Klinikum Rechts der Isar, Technical University Munich, Munich, Germany. 4. Department of Digestive and Oncological Surgery, University Lille, and Claude Huriez University Hospital, Lille, France. 5. Faculdade Medicina, Universidade Lisboa, and General Surgery Department, Hospital Garcia de Orta, Lisbon, Portugal. 6. Department of Surgery, St. James's Hospital and Trinity College Dublin, Ireland. 7. Generalsekretär, Deutsche Gesellschaft für Chirurgie, Berlin, Germany. 8. GB Morgagni-L Pierantoni Surgical Department, Forlì, Italy. 9. Department of Visceral, Transplant, Thoracic and Vascular Surgery, University Hospital of Leipzig, Leipzig, Germany. 10. Experimental Pathology and Therapeutics Group and Surgical Oncology Department, Portuguese Institute of Oncology, Porto, Portugal. 11. Department of Surgery, Aarhus University Hospital, Aarhus C, Denmark. 12. Department of Surgery, Mercy University Hospital, Cork, Republic of Ireland. 13. Department of General Surgery, Fondazione Policlinico Gemelli, Rome, Italy. 14. Department of Gastrointestinal Surgery, San Raffaele Hospital, Milan, Italy. 15. Department of Digestive Tract Surgery, IEO, Milan, Italy. 16. Department of Oncology, Head, Digestive and Surgical Oncology, Gonzaga University of Torino, and San Luigi University Hospital, Orbassano, Italy. 17. 2nd Department of General and Oncological Surgery, Wroclaw Medical University, Wroclaw, Poland. 18. Division of Abdominal Surgery, University Hospital of Geneva, Geneva, Switzerland. 19. Department of Surgery I, Jagiellonian University, Krakow, Poland. 20. Department of Surgical Oncology, Medical University of Lublin, Lublin, Poland. 21. Department of Surgery, Section of Gastrointestinal Surgery, Hospital Universitario del Mar, Universitat Autònoma de Barcelona, and Hospital Universitario del Mar Medical Research Institute (IMIM), Barcelona, Spain. 22. Center for Visceral, Thoracic and Specialized Tumor Surgery, Hirslanden Medical Center, Zurich, Switzerland. 23. Department of Surgery, Erasmus Medical Center, Rotterdam, The Netherlands. 24. Department of Surgery, Leiden University Medical Center, Leiden, The Netherlands. 25. Department of Surgery, University Medical Center, Amsterdam, The Netherlands. 26. Department of Surgery, Netherlands Cancer Institute, and Antoni van Leeuwenhoek Hospital, Amsterdam, The Netherlands. 27. IGIER, Università Bocconi, Milan, Italy. 28. Contilia Center for Esophageal Diseases, Elisabeth Hospital, Essen, Germany. 29. Department of Surgery, Royal Marsden NHS Foundation Trust, London, United Kingdom.
Abstract
OBJECTIVE: Utilizing a standardized dataset based on a newly developed list of 27 univocally defined complications, this study analyzed data to assess the incidence and grading of complications and evaluate outcomes associated with gastrectomy for cancer in Europe. SUMMARY BACKGROUND DATA: The absence of a standardized system for recording gastrectomy-associated complications makes it difficult to compare results from different hospitals and countries. METHODS: Using a secure online platform (www.gastrodata.org), referral centers for gastric cancer in 11 European countries belonging to the Gastrectomy Complications Consensus Group recorded clinical, oncological, and surgical data, and outcome measures at hospital discharge and at 30 and 90 days postoperatively. This retrospective observational study included all consecutive resections over a 2-year period. RESULTS: A total of 1349 gastrectomies performed between January 2017 and December 2018 were entered into the database. Neoadjuvant chemotherapy was administered to 577 patients (42.8%). Total (46.1%) and subtotal (46.4%) gastrectomy were the predominant resections. D2 or D2+ lymphadenectomy was performed in almost 80% of operations. The overall complications' incidence was 29.8%; 402 patients developed 625 complications, with the most frequent being nonsurgical infections (23%), anastomotic leak (9.8%), other postoperative abnormal fluid from drainage and/or abdominal collections (9.3%), pleural effusion (8.3%), postoperative bleeding (5.6%), and other major complications requiring invasive treatment (5.6%). The median Clavien-Dindo score and Comprehensive Complications Index were IIIa and 26.2, respectively. In-hospital, 30-day, and 90-day mortality were 3.2%, 3.6%, and 4.5%, respectively. CONCLUSIONS: The use of a standardized platform to collect European data on perioperative complications revealed that gastrectomy for gastric cancer is still associated with heavy morbidity and mortality. Actions are needed to limit the incidence of, and to effectively treat, the most frequent and most lethal complications.
OBJECTIVE: Utilizing a standardized dataset based on a newly developed list of 27 univocally defined complications, this study analyzed data to assess the incidence and grading of complications and evaluate outcomes associated with gastrectomy for cancer in Europe. SUMMARY BACKGROUND DATA: The absence of a standardized system for recording gastrectomy-associated complications makes it difficult to compare results from different hospitals and countries. METHODS: Using a secure online platform (www.gastrodata.org), referral centers for gastric cancer in 11 European countries belonging to the Gastrectomy Complications Consensus Group recorded clinical, oncological, and surgical data, and outcome measures at hospital discharge and at 30 and 90 days postoperatively. This retrospective observational study included all consecutive resections over a 2-year period. RESULTS: A total of 1349 gastrectomies performed between January 2017 and December 2018 were entered into the database. Neoadjuvant chemotherapy was administered to 577 patients (42.8%). Total (46.1%) and subtotal (46.4%) gastrectomy were the predominant resections. D2 or D2+ lymphadenectomy was performed in almost 80% of operations. The overall complications' incidence was 29.8%; 402 patients developed 625 complications, with the most frequent being nonsurgical infections (23%), anastomotic leak (9.8%), other postoperative abnormal fluid from drainage and/or abdominal collections (9.3%), pleural effusion (8.3%), postoperative bleeding (5.6%), and other major complications requiring invasive treatment (5.6%). The median Clavien-Dindo score and Comprehensive Complications Index were IIIa and 26.2, respectively. In-hospital, 30-day, and 90-day mortality were 3.2%, 3.6%, and 4.5%, respectively. CONCLUSIONS: The use of a standardized platform to collect European data on perioperative complications revealed that gastrectomy for gastric cancer is still associated with heavy morbidity and mortality. Actions are needed to limit the incidence of, and to effectively treat, the most frequent and most lethal complications.
Authors: J Weindelmayer; V Mengardo; A Veltri; G L Baiocchi; S Giacopuzzi; G Verlato; G de Manzoni Journal: Trials Date: 2021-02-17 Impact factor: 2.279