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Unplanned reoperation after radical gastrectomy for gastric cancer: causes, risk factors, and long-term prognostic influence

Authors Zuo X, Cai J, Chen Z, Zhang Y, Wu J, Wu L, Wang J

Received 8 February 2018

Accepted for publication 16 April 2018

Published 28 May 2018 Volume 2018:14 Pages 965—972

DOI https://doi.org/10.2147/TCRM.S164929

Checked for plagiarism Yes

Review by Single-blind

Peer reviewers approved by Dr Colin Mak

Peer reviewer comments 3

Editor who approved publication: Professor Deyun Wang


Xueliang Zuo,1,* Juan Cai,2,* Zhiqiang Chen,3,* Yao Zhang,3 Jian Wu,1 Liangyu Wu,4 Jinguo Wang1

1Department of Gastrointestinal Surgery, The First Affiliated Hospital, Yijishan Hospital of Wannan Medical College, Wuhu, China; 2Department of Oncology, The First Affiliated Hospital, Yijishan Hospital of Wannan Medical College, Wuhu, China; 3Hepatobiliary Center, The First Affiliated Hospital of Nanjing Medical University, Key Laboratory of Liver Transplantation, Chinese Academy of Medical Sciences, Nanjing, China; 4Department of General Surgery, Qingyang County People’s Hospital, Qingyang, China

*These authors contributed equally to this work

Purpose: Unplanned reoperation (URO) after radical gastrectomy for gastric cancer (GC) mostly results from serious postoperative complications. At present, there is still controversy over the predictive factors for URO. Our goal was to identify the risk factors for URO and to investigate its potential impact on long-term survival.
Patients and methods: We included 2,852 GC patients who underwent a gastrectomy. Multivariate logistic regression analyses were performed to determine the risk factors for URO. Patients were randomly selected from the non-URO group by 1:4 propensity score matching with multiple parameters with patients from the URO group. The survival disparity of 34 URO patients and 136 non-URO patients was examined using the Kaplan–Meier method and the multivariate Cox proportional hazard model.
Results: The incidence of URO was 1.4% (39/2, 852). The primary cause of URO was intra-abdominal bleeding (53.9%, 21/39). Multivariate logistic regression analyses revealed that male gender (OR = 4.630, 95% CI = 1.412–15.152, P = 0.011), diabetes (OR = 4.189, 95% CI = 1.705–10.290, P = 0.002), and preoperative hypoproteinemia (OR = 2.305, 95% CI = 1.079–4.923, P = 0.031) were independent risk factors for URO. With regard to early surgical outcomes, patients undergoing URO had a longer hospital stay (P < 0.001), higher incidence of postoperative complications (P < 0.001), and greater mortality (P < 0.001) compared with the non-URO group. No significant correlation was found between URO and cancer-specific survival in univariate (P = 0.275) and multivariate (P = 0.090) survival analyses.
Conclusion: Male gender, diabetes, and preoperative hypoproteinemia were suggested as independent risk factors for URO. URO was associated with longer hospital stay and increased perioperative mortality, but might not be correlated with long-term mortality.

Keywords:
reoperation, stomach neoplasm, gastrectomy, postoperative complications

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