Postoperative complications and prognosis after radical gastrectomy for gastric cancer: a systematic review and meta-analysis of observational studies

Shiqi Wang, Lei Xu, Quan Wang, Jipeng Li, Bin Bai, Zhengyan Li, Xiaoyong Wu, Pengfei Yu, Xuzhao Li, Jichao Yin, Shiqi Wang, Lei Xu, Quan Wang, Jipeng Li, Bin Bai, Zhengyan Li, Xiaoyong Wu, Pengfei Yu, Xuzhao Li, Jichao Yin

Abstract

Background: Many observational studies have reported correlations between postoperative complications and prognosis after radical gastrectomy but the results are controversial. This meta-analysis was performed to investigate whether there is a correlation between postoperative complications and prognosis after radical gastrectomy.

Methods: Literature searches were performed in PubMed, EMBASE, and the Cochrane Library. Studies that investigated the correlations between any postoperative complications and prognosis after radical gastrectomy were included. 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. Subgroup analyses were performed within pathological stages I, II, and III.

Results: Sixteen retrospective studies comprising 12,065 patients were included. 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). 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 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.

Conclusions: Postoperative complications correlate with poor prognosis after radical gastrectomy. Such correlations are found in stage II and III gastric cancer patients but remain to be determined in stage I gastric cancer patients.

Keywords: Complications; Prognosis; Radical gastrectomy; Stomach neoplasms.

Conflict of interest statement

Ethics approval and consent to participate

All analyses were based on previous published studies, thus no ethical approval and patient consent are required.

Consent for publication

Not applicable

Competing interests

The authors declare that they have no competing interests.

Publisher’s Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Figures

Fig. 1
Fig. 1
Flow chart of articles identified, included, and excluded
Fig. 2
Fig. 2
The association of postoperative complications with overall survival
Fig. 3
Fig. 3
Funnel plots for visual inspection of publication bias
Fig. 4
Fig. 4
The association of postoperative complications with recurrence-free survival
Fig. 5
Fig. 5
The association of postoperative complications with overall survival and recurrence-free survival within varied pathological stages

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