The PubMed, EMBASE, and Cochrane Library databases were searched from inception until February 24, 2019, for studies that assessed the relationship between postoperative complications and prognosis after radical gastrectomy. In the meta-analysis, the correlations between postoperative complications and prognosis after radical gastrectomy were assessed. The existence of that correlation may not only lead to a consideration of shortening follow-up interval and enforcing adjuvant chemotherapy in patient who have developed postoperative complications, but may also underline the necessity of neoadjuvant chemotherapy and stress control management in patients with high risk of developing postoperative complications to reduce the hazard for long term prognosis. Given the prevalence of postoperative complications after radical gastrectomy, it is important to determine whether a correlation exists between postoperative complications and poor prognosis.
Additionally, the correlations between postoperative complications and long-term prognosis in different stages are controversial and are based on subgroup analyses with small sample sizes. Although some reports have negative findings, other studies have demonstrated that overall postoperative complications, infectious complications, and gastrointestinal leakages are all correlated with poor overall survival (OS) and/or recurrence-free survival (RFS).
Currently, increasing numbers of observational studies have investigated the correlation between postoperative complications and long-term prognosis after radical gastrectomy. In addition to undermining the short-term survival, postoperative complications may also be correlated with long term prognosis. The incidence of postoperative complications after radical gastrectomy remains high, and the estimated incidence is 12.8 to 14%. Such correlations are found in stage II and III gastric cancer patients but remain to be determined in stage I gastric cancer patients. Postoperative complications correlate with poor prognosis after radical gastrectomy. The pooled HR (95% CI) for any reported postoperative complications regarding OS for stage I, II, and III diseases was 2.39 (0.77, 7.46), 4.35 (2.58, 7.35), and 2.84 (1.77, 4.56), respectively. The pooled HR (95% CI) for infectious complications and leakage regarding OS was 1.86 (1.22, 2.83) and 2.02 (1.02, 4.00), respectively.
The pooled HR (95% CI) for complications regarding OS was 1.79 (1.39, 2.30) and was 1.40 (1.06, 1.84) after excluding in-hospital mortality the pooled HR (95% CI) for complications regarding RFS was 1.28 (1.10, 1.49). Sixteen retrospective studies comprising 12,065 patients were included. Subgroup analyses were performed within pathological stages I, II, and III. The pooled hazard ratio (HR) with 95% confidence interval (CI) for postoperative complications regarding overall survival (OS) or recurrence-free survival (RFS) was calculated by using RevMan 5.3.5. Studies that investigated the correlations between any postoperative complications and prognosis after radical gastrectomy were included. Literature searches were performed in PubMed, EMBASE, and the Cochrane Library. This meta-analysis was performed to investigate whether there is a correlation between postoperative complications and prognosis after radical gastrectomy. Many observational studies have reported correlations between postoperative complications and prognosis after radical gastrectomy but the results are controversial.
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