Impact of postoperative complications on clinical outcomes after gastrectomy for cancer: multicentre study

Sander J. M. van Hootegem; Margrietha van der Linde; Marcel A. Schneider; Jeesun Kim; Felix Berlth; Yutaka Sugita; Peter P. Grimminger; Gian Luca Baiocchi; Giovanni de Manzoni; Maria Bencivenga; Suzanne Gisbertz; Souya Nunobe; Han-Kwang Yang; Christian A. Gutschow; Sjoerd M. Lagarde; Hester F. Lingsma; Bas P. L. Wijnhoven; Hidde Overtoom; Ines Gockel; René Thieme; Ewen A. Griffiths; William Butterworth; Henrik Nienhüser; Beat Müller; Nerma Crnovrsanin; Felix Nickel; Suzanne S. Gisbertz; Mark I. van Berge Henegouwen; Philip H. Pucher; Kashuf Khan; Asif Chaudry; Pranav H. Patel; Manuel Pera; Mariagiulia Dal Cero; Carlos Garcia; Guillermo Martinez Salinas; Paulo Kassab; Osvaldo Antônio Prado Castro; Enrique Norero; Paul Wisniowski; Luke Randall Putnam; Guillaume Piessen; Pietro Maria Lombardi; Giovanni Ferrari; Rita Gudaityte; Almantas Maleckas; Leanne Prodehl; Antonio Castaldi; Michel Prudhomme; Simone Giacopuzzi; Riccardo Rosati; Francesco Puccetti; Domenico D'Ugo; Daniel Gero; The GastroBenchmark Consortium; The GASTRODATA Consortium

doi:10.1093/bjs/znaf043

Impact of postoperative complications on clinical outcomes after gastrectomy for cancer: multicentre study

Sander J. M. van Hootegem^*
, Margrietha van der Linde
, Marcel A. Schneider
, Jeesun Kim
, Felix Berlth
, Yutaka Sugita
, Peter P. Grimminger
, Gian Luca Baiocchi
, Giovanni de Manzoni
, Maria Bencivenga
, Suzanne Gisbertz
, Souya Nunobe
, Han-Kwang Yang
, Christian A. Gutschow
, Sjoerd M. Lagarde
, Hester F. Lingsma
, Bas P. L. Wijnhoven
, Hidde Overtoom
, Ines Gockel
, René Thieme

Ewen A. Griffiths, William Butterworth, Henrik Nienhüser, Beat Müller, Nerma Crnovrsanin, Felix Nickel, Suzanne S. Gisbertz, Mark I. van Berge Henegouwen, Philip H. Pucher, Kashuf Khan, Asif Chaudry, Pranav H. Patel, Manuel Pera, Mariagiulia Dal Cero, Carlos Garcia, Guillermo Martinez Salinas, Paulo Kassab, Osvaldo Antônio Prado Castro, Enrique Norero, Paul Wisniowski, Luke Randall Putnam, Guillaume Piessen, Pietro Maria Lombardi, Giovanni Ferrari, Rita Gudaityte, Almantas Maleckas, Leanne Prodehl, Antonio Castaldi, Michel Prudhomme, Simone Giacopuzzi, Riccardo Rosati, Francesco Puccetti, Domenico D'Ugo, Daniel Gero, The GastroBenchmark Consortium, The GASTRODATA Consortium

^*Corresponding author for this work

Erasmus MC Rotterdam
University of Zurich
Seoul National University
Johannes Gutenberg University Mainz
University of Tübingen
Japanese Foundation for Cancer Research
University Hospital of Brescia
Azienda Ospedaliera Universitaria Integrata Verona
University of Amsterdam
Amsterdam UMC
Leipzig University
University Hospitals Birmingham NHS Foundation Trust
Heidelberg University
University of Hamburg
Portsmouth Hospitals University NHS Trust
Royal Marsden NHS Foundation Trust
Hospital del Mar
Hospital Clínico San Borja Arriarán
Santa Casa of Sao Paulo Medical School
Pontificia Universidad Católica de Chile
University of Southern California
CHU Lille
Asst Grande Ospedale Metropolitano Niguarda
Lithuanian University of Health Sciences
University of the Witwatersrand
Hôpital Universitaire Carémeau
IRCCS Ospedale San Raffaele
Alcohol Use Disorder and Alcohol Related Disease Unit, Department of Internal Medicine and Gastroenterology, Fondazione Policlinico Universitario A. Gemelli IRCCS
Antoni van Leeuwenhoek Hospital
St. James’s Hospital
Morgagni-Pierantoni Hospital
University of Duisburg-Essen
University of Geneva
Jagiellonian University in Kraków
Leiden University
University of Lisbon
Guy's and St Thomas' NHS Foundation Trust
Medical University of Lublin
IRCCS Istituto Europeo di Oncologia - Milano
Technical University of Munich
Instituto Português de Oncologia do Porto Francisco Gentil E.P.E.
Azienda Ospedaliera S. Luigi Gonzaga
Wrocław Medical University
Hirslanden Medical Centre
University College Cork

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Abstract

Background: To reduce the clinical and economic burden of complications after gastrectomy for gastric cancer, specific complications should be targeted to effectively allocate healthcare resources for quality improvement and preventive measures. The aim of this study was to assess the impact of complications on clinical outcomes. Methods: This was a retrospective multicentre study of patients who underwent (sub)total gastrectomy for gastric or junctional adenocarcinoma at 43 centres in 16 countries between 2017 and 2021. Outcomes were escalation of care, reoperation, prolonged hospital stay (greater than the 75th percentile), readmission, and 30-day mortality. Adjusted relative risks and population attributable fractions were estimated for specific complication-outcome pairs. The population attributable fraction represents the percentage reduction in the frequency of an adverse outcome if a complication could be completely prevented in the population. Results: In total, 7829 patients were included. Postoperative complications occurred in 1884 patients (24.1%). The most frequent complications were pulmonary complications (436 patients (5.6%)), anastomotic leakage (363 patients (4.6%)), and abdominal collection (301 patients (3.8%)). Anastomotic leakage, cardiac complications, and pulmonary complications had the greatest impact on 30-day mortality (population attributable fraction 26.6% (95% c.i. 14.5% to 38.6%), 18.7% (95% c.i. 9.4% to 28.0%), and 15.6% (95% c.i. 12.0% to 30.0%) respectively). Anastomotic leakage and pulmonary complications had the greatest impact on escalation of care (population attributable fraction 26.3% (95% c.i. 20.6% to 32.0%) and 18.4% (95% c.i. 11.7% to 25.2%) respectively), whereas anastomotic leakage and intra-abdominal bleeding had the greatest impact on reoperation (population attributable fraction 31.6% (95% c.i. 26.4% to 36.9%) and 8.5% (95% c.i. 5.5% to 11.5%) respectively). Most of the studied complications contributed to a prolonged hospital stay, whereas the contribution of complications to readmission did not exceed 15.9%. Subgroup analysis showed regional variation in the impact of complications. Conclusion: Anastomotic leakage had the largest overall negative impact on clinical outcomes after gastrectomy for gastric adenocarcinoma. Reducing the incidence of anastomotic leakage and pulmonary complications would have the most impact on the burden of complications.

Original language	English
Article number	znaf043
Journal	British journal of surgery
Volume	112
Issue number	4
DOIs	https://doi.org/10.1093/bjs/znaf043
Publication status	Published - 1 Apr 2025

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SDG 3 Good Health and Well-being

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van Hootegem, S. J. M., van der Linde, M., Schneider, M. A., Kim, J., Berlth, F., Sugita, Y., Grimminger, P. P., Baiocchi, G. L., de Manzoni, G., Bencivenga, M., Gisbertz, S., Nunobe, S., Yang, H.-K., Gutschow, C. A., Lagarde, S. M., Lingsma, H. F., Wijnhoven, B. P. L., Overtoom, H., Gockel, I., ... The GASTRODATA Consortium (2025). Impact of postoperative complications on clinical outcomes after gastrectomy for cancer: multicentre study. British journal of surgery, 112(4), Article znaf043. https://doi.org/10.1093/bjs/znaf043

@article{65a24a8ea9ab43c7aebc5f24c7f382c8,

title = "Impact of postoperative complications on clinical outcomes after gastrectomy for cancer: multicentre study",

abstract = "Background: To reduce the clinical and economic burden of complications after gastrectomy for gastric cancer, specific complications should be targeted to effectively allocate healthcare resources for quality improvement and preventive measures. The aim of this study was to assess the impact of complications on clinical outcomes. Methods: This was a retrospective multicentre study of patients who underwent (sub)total gastrectomy for gastric or junctional adenocarcinoma at 43 centres in 16 countries between 2017 and 2021. Outcomes were escalation of care, reoperation, prolonged hospital stay (greater than the 75th percentile), readmission, and 30-day mortality. Adjusted relative risks and population attributable fractions were estimated for specific complication-outcome pairs. The population attributable fraction represents the percentage reduction in the frequency of an adverse outcome if a complication could be completely prevented in the population. Results: In total, 7829 patients were included. Postoperative complications occurred in 1884 patients (24.1\%). The most frequent complications were pulmonary complications (436 patients (5.6\%)), anastomotic leakage (363 patients (4.6\%)), and abdominal collection (301 patients (3.8\%)). Anastomotic leakage, cardiac complications, and pulmonary complications had the greatest impact on 30-day mortality (population attributable fraction 26.6\% (95\% c.i. 14.5\% to 38.6\%), 18.7\% (95\% c.i. 9.4\% to 28.0\%), and 15.6\% (95\% c.i. 12.0\% to 30.0\%) respectively). Anastomotic leakage and pulmonary complications had the greatest impact on escalation of care (population attributable fraction 26.3\% (95\% c.i. 20.6\% to 32.0\%) and 18.4\% (95\% c.i. 11.7\% to 25.2\%) respectively), whereas anastomotic leakage and intra-abdominal bleeding had the greatest impact on reoperation (population attributable fraction 31.6\% (95\% c.i. 26.4\% to 36.9\%) and 8.5\% (95\% c.i. 5.5\% to 11.5\%) respectively). Most of the studied complications contributed to a prolonged hospital stay, whereas the contribution of complications to readmission did not exceed 15.9\%. Subgroup analysis showed regional variation in the impact of complications. Conclusion: Anastomotic leakage had the largest overall negative impact on clinical outcomes after gastrectomy for gastric adenocarcinoma. Reducing the incidence of anastomotic leakage and pulmonary complications would have the most impact on the burden of complications.",

author = "\{van Hootegem\}, \{Sander J. M.\} and \{van der Linde\}, Margrietha and Schneider, \{Marcel A.\} and Jeesun Kim and Felix Berlth and Yutaka Sugita and Grimminger, \{Peter P.\} and Baiocchi, \{Gian Luca\} and \{de Manzoni\}, Giovanni and Maria Bencivenga and Suzanne Gisbertz and Souya Nunobe and Han-Kwang Yang and Gutschow, \{Christian A.\} and Lagarde, \{Sjoerd M.\} and Lingsma, \{Hester F.\} and Wijnhoven, \{Bas P. L.\} and Hidde Overtoom and Ines Gockel and Ren{\'e} Thieme and Griffiths, \{Ewen A.\} and William Butterworth and Henrik Nienh{\"u}ser and Beat M{\"u}ller and Nerma Crnovrsanin and Felix Nickel and Gisbertz, \{Suzanne S.\} and \{van Berge Henegouwen\}, \{Mark I.\} and Pucher, \{Philip H.\} and Kashuf Khan and Asif Chaudry and Patel, \{Pranav H.\} and Manuel Pera and Cero, \{Mariagiulia Dal\} and Carlos Garcia and Salinas, \{Guillermo Martinez\} and Paulo Kassab and Castro, \{Osvaldo Ant{\^o}nio Prado\} and Enrique Norero and Paul Wisniowski and Putnam, \{Luke Randall\} and Guillaume Piessen and Lombardi, \{Pietro Maria\} and Giovanni Ferrari and Rita Gudaityte and Almantas Maleckas and Leanne Prodehl and Antonio Castaldi and Michel Prudhomme and Simone Giacopuzzi and Riccardo Rosati and Francesco Puccetti and Domenico D'Ugo and Daniel Gero and \{The GastroBenchmark Consortium\} and Hyuk-Joon Lee and Justine Lerooy and \{The GASTRODATA Consortium\} and \{van Sandick\}, \{Johanna Wilhelmina\} and Jessie Elliott and Paolo Morgagni and H{\"o}lscher, \{Arnulf H.\} and Martin Hemmerich and Stefan M{\"o}nig and Mickael Chevallay and Piotr Kolodziejczyk and Henk Hartgrink and \{da Costa\}, \{Paulo Matos\} and Borges, \{Filipe Castro\} and Andrew Davies and Cara Baker and William Allum and Sacheen Kumar and Wojciech Polkowski and Karol Rawicz-Pruszy{\'n}ski and Romario, \{Uberto Fumagalli\} and \{de Pascale\}, Stefano and Antonio Tarasconi and Daniel Reim and Ilaria Pergolini and Santos, \{Lucio Lara\} and Martins, \{Pedro Carvalho\} and Alberto Biondi and Maurizio Degiuli and Rossella Reddavid and Wojciech Kielan and Schneider, \{Paul Magnus\} and Thomas Murphy",

note = "Publisher Copyright: {\textcopyright} 2025 The Author(s). Published by Oxford University Press on behalf of BJS Foundation Ltd.",

year = "2025",

month = apr,

day = "1",

doi = "10.1093/bjs/znaf043",

language = "English",

volume = "112",

journal = "British journal of surgery",

issn = "0007-1323",

publisher = "John Wiley and Sons Ltd.",

number = "4",

}

van Hootegem, SJM, van der Linde, M, Schneider, MA, Kim, J, Berlth, F, Sugita, Y, Grimminger, PP, Baiocchi, GL, de Manzoni, G, Bencivenga, M, Gisbertz, S, Nunobe, S, Yang, H-K, Gutschow, CA, Lagarde, SM, Lingsma, HF, Wijnhoven, BPL, Overtoom, H, Gockel, I, Thieme, R, Griffiths, EA, Butterworth, W, Nienhüser, H, Müller, B, Crnovrsanin, N, Nickel, F, Gisbertz, SS , van Berge Henegouwen, MI, Pucher, PH, Khan, K, Chaudry, A, Patel, PH, Pera, M, Cero, MD, Garcia, C, Salinas, GM, Kassab, P, Castro, OAP, Norero, E, Wisniowski, P, Putnam, LR, Piessen, G, Lombardi, PM, Ferrari, G, Gudaityte, R, Maleckas, A, Prodehl, L, Castaldi, A, Prudhomme, M, Giacopuzzi, S, Rosati, R, Puccetti, F, D'Ugo, D, Gero, D, The GastroBenchmark Consortium & The GASTRODATA Consortium 2025, 'Impact of postoperative complications on clinical outcomes after gastrectomy for cancer: multicentre study', British journal of surgery, vol. 112, no. 4, znaf043. https://doi.org/10.1093/bjs/znaf043

TY - JOUR

T1 - Impact of postoperative complications on clinical outcomes after gastrectomy for cancer

T2 - multicentre study

AU - van Hootegem, Sander J. M.

AU - van der Linde, Margrietha

AU - Schneider, Marcel A.

AU - Kim, Jeesun

AU - Berlth, Felix

AU - Sugita, Yutaka

AU - Grimminger, Peter P.

AU - Baiocchi, Gian Luca

AU - de Manzoni, Giovanni

AU - Bencivenga, Maria

AU - Gisbertz, Suzanne

AU - Nunobe, Souya

AU - Yang, Han-Kwang

AU - Gutschow, Christian A.

AU - Lagarde, Sjoerd M.

AU - Lingsma, Hester F.

AU - Wijnhoven, Bas P. L.

AU - Overtoom, Hidde

AU - Gockel, Ines

AU - Thieme, René

AU - Griffiths, Ewen A.

AU - Butterworth, William

AU - Nienhüser, Henrik

AU - Müller, Beat

AU - Crnovrsanin, Nerma

AU - Nickel, Felix

AU - Gisbertz, Suzanne S.

AU - van Berge Henegouwen, Mark I.

AU - Pucher, Philip H.

AU - Khan, Kashuf

AU - Chaudry, Asif

AU - Patel, Pranav H.

AU - Pera, Manuel

AU - Cero, Mariagiulia Dal

AU - Garcia, Carlos

AU - Salinas, Guillermo Martinez

AU - Kassab, Paulo

AU - Castro, Osvaldo Antônio Prado

AU - Norero, Enrique

AU - Wisniowski, Paul

AU - Putnam, Luke Randall

AU - Piessen, Guillaume

AU - Lombardi, Pietro Maria

AU - Ferrari, Giovanni

AU - Gudaityte, Rita

AU - Maleckas, Almantas

AU - Prodehl, Leanne

AU - Castaldi, Antonio

AU - Prudhomme, Michel

AU - Giacopuzzi, Simone

AU - Rosati, Riccardo

AU - Puccetti, Francesco

AU - D'Ugo, Domenico

AU - Gero, Daniel

AU - The GastroBenchmark Consortium

AU - Lee, Hyuk-Joon

AU - Lerooy, Justine

AU - The GASTRODATA Consortium

AU - van Sandick, Johanna Wilhelmina

AU - Elliott, Jessie

AU - Morgagni, Paolo

AU - Hölscher, Arnulf H.

AU - Hemmerich, Martin

AU - Mönig, Stefan

AU - Chevallay, Mickael

AU - Kolodziejczyk, Piotr

AU - Hartgrink, Henk

AU - da Costa, Paulo Matos

AU - Borges, Filipe Castro

AU - Davies, Andrew

AU - Baker, Cara

AU - Allum, William

AU - Kumar, Sacheen

AU - Polkowski, Wojciech

AU - Rawicz-Pruszyński, Karol

AU - Romario, Uberto Fumagalli

AU - de Pascale, Stefano

AU - Tarasconi, Antonio

AU - Reim, Daniel

AU - Pergolini, Ilaria

AU - Santos, Lucio Lara

AU - Martins, Pedro Carvalho

AU - Biondi, Alberto

AU - Degiuli, Maurizio

AU - Reddavid, Rossella

AU - Kielan, Wojciech

AU - Schneider, Paul Magnus

AU - Murphy, Thomas

PY - 2025/4/1

Y1 - 2025/4/1

N2 - Background: To reduce the clinical and economic burden of complications after gastrectomy for gastric cancer, specific complications should be targeted to effectively allocate healthcare resources for quality improvement and preventive measures. The aim of this study was to assess the impact of complications on clinical outcomes. Methods: This was a retrospective multicentre study of patients who underwent (sub)total gastrectomy for gastric or junctional adenocarcinoma at 43 centres in 16 countries between 2017 and 2021. Outcomes were escalation of care, reoperation, prolonged hospital stay (greater than the 75th percentile), readmission, and 30-day mortality. Adjusted relative risks and population attributable fractions were estimated for specific complication-outcome pairs. The population attributable fraction represents the percentage reduction in the frequency of an adverse outcome if a complication could be completely prevented in the population. Results: In total, 7829 patients were included. Postoperative complications occurred in 1884 patients (24.1%). The most frequent complications were pulmonary complications (436 patients (5.6%)), anastomotic leakage (363 patients (4.6%)), and abdominal collection (301 patients (3.8%)). Anastomotic leakage, cardiac complications, and pulmonary complications had the greatest impact on 30-day mortality (population attributable fraction 26.6% (95% c.i. 14.5% to 38.6%), 18.7% (95% c.i. 9.4% to 28.0%), and 15.6% (95% c.i. 12.0% to 30.0%) respectively). Anastomotic leakage and pulmonary complications had the greatest impact on escalation of care (population attributable fraction 26.3% (95% c.i. 20.6% to 32.0%) and 18.4% (95% c.i. 11.7% to 25.2%) respectively), whereas anastomotic leakage and intra-abdominal bleeding had the greatest impact on reoperation (population attributable fraction 31.6% (95% c.i. 26.4% to 36.9%) and 8.5% (95% c.i. 5.5% to 11.5%) respectively). Most of the studied complications contributed to a prolonged hospital stay, whereas the contribution of complications to readmission did not exceed 15.9%. Subgroup analysis showed regional variation in the impact of complications. Conclusion: Anastomotic leakage had the largest overall negative impact on clinical outcomes after gastrectomy for gastric adenocarcinoma. Reducing the incidence of anastomotic leakage and pulmonary complications would have the most impact on the burden of complications.

AB - Background: To reduce the clinical and economic burden of complications after gastrectomy for gastric cancer, specific complications should be targeted to effectively allocate healthcare resources for quality improvement and preventive measures. The aim of this study was to assess the impact of complications on clinical outcomes. Methods: This was a retrospective multicentre study of patients who underwent (sub)total gastrectomy for gastric or junctional adenocarcinoma at 43 centres in 16 countries between 2017 and 2021. Outcomes were escalation of care, reoperation, prolonged hospital stay (greater than the 75th percentile), readmission, and 30-day mortality. Adjusted relative risks and population attributable fractions were estimated for specific complication-outcome pairs. The population attributable fraction represents the percentage reduction in the frequency of an adverse outcome if a complication could be completely prevented in the population. Results: In total, 7829 patients were included. Postoperative complications occurred in 1884 patients (24.1%). The most frequent complications were pulmonary complications (436 patients (5.6%)), anastomotic leakage (363 patients (4.6%)), and abdominal collection (301 patients (3.8%)). Anastomotic leakage, cardiac complications, and pulmonary complications had the greatest impact on 30-day mortality (population attributable fraction 26.6% (95% c.i. 14.5% to 38.6%), 18.7% (95% c.i. 9.4% to 28.0%), and 15.6% (95% c.i. 12.0% to 30.0%) respectively). Anastomotic leakage and pulmonary complications had the greatest impact on escalation of care (population attributable fraction 26.3% (95% c.i. 20.6% to 32.0%) and 18.4% (95% c.i. 11.7% to 25.2%) respectively), whereas anastomotic leakage and intra-abdominal bleeding had the greatest impact on reoperation (population attributable fraction 31.6% (95% c.i. 26.4% to 36.9%) and 8.5% (95% c.i. 5.5% to 11.5%) respectively). Most of the studied complications contributed to a prolonged hospital stay, whereas the contribution of complications to readmission did not exceed 15.9%. Subgroup analysis showed regional variation in the impact of complications. Conclusion: Anastomotic leakage had the largest overall negative impact on clinical outcomes after gastrectomy for gastric adenocarcinoma. Reducing the incidence of anastomotic leakage and pulmonary complications would have the most impact on the burden of complications.

UR - https://www.scopus.com/pages/publications/105002023122

U2 - 10.1093/bjs/znaf043

DO - 10.1093/bjs/znaf043

M3 - Article

C2 - 40156166

SN - 0007-1323

VL - 112

JO - British journal of surgery

JF - British journal of surgery

IS - 4

M1 - znaf043

ER -

Impact of postoperative complications on clinical outcomes after gastrectomy for cancer: multicentre study

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