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開催概要
開催回
第58回・2020年・京都
 

胃癌術後合併症が予後に与える影響

演題番号 : WS18-7

[筆頭演者]
齊藤 博昭:1 
[共同演者]
村上 裕樹:1、山田 敬教:1、前田 佳彦:1、山代 豊:1、山口 由美:1、西土井 英昭:1、清水 翔太:2、松永 知之:2、藤原 義之:2

1:鳥取赤十字病院・外科、2:鳥取大学・病態制御外科

 

Purpose: Postoperative complications worsen the prognosis of gastric cancer (GC) patients. Clavien-Dindo classification (CDC) is used to evaluate postoperative complications. The prognostic significance of the comprehensive complication index (CCI), a new tool to evaluate postoperative complications, remains unclear. Therefore, the aim of the current study was to investigate the prognostic significance of CCI in GC patients.
Methods: This study included 452 gastric adenocarcinoma patients who underwent curative surgery.
Results: CCI was significantly higher in older patients (≧70 years; P<0.0001), male patients (P<0.0001), those with lymphatic invasion (P0.039), and those with vascular invasion (P=0.037). Five-year overall survival (OS) and disease-specific survival (DSS) rates were significantly higher in patients without postoperative complication and those with CDC grade 1 (80.4%) compared with those with CDC grade 2/3/4 (80.4% vs. 66.2%, P = 0.0011; 89.7% vs. 82.3%; P=0.045, respectively). In CDC grade 2/3/4 patients, 5-year OS and DSS rates were significantly lower in the CCIHigh group (≧32.15) compared with CCILow group (<32.15; 47.5% vs. 74.9%, P=0.0086; 63.1% vs. 90.0%, P=0.0003). Multivariate analysis identified that CCI was an independent prognostic indicator for both OS and DSS in patients with CDC grade 2/3/4. The post-surgical interval before starting S-1 adjuvant chemotherapy was significantly longer in CCIHigh group than in CCILow group in stage II / III GC patients with CDC grade 2/3/4 (81.1±46.7 vs. 38.7±10.1, respectively; P=0.034).
Conclusions: CCI was closely associated with prognosis of patients with CDC grade 2/3/4 and may be a prognostic indicator. Delay in the initiation of S-1 adjuvant chemotherapy might be one of the reasons worsen the prognosis of GC patients in the CCIHigh group. Every effort should be made to avoid the development of postoperative complications to improve the prognosis of GC patients.

キーワード

臓器別:胃・十二指腸

手法別:手術療法

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