Total gastrectomy for gastric cancer is associated with significant 30-day mortality. However, there is little data available that reveals the same parameter within a period of 90 days.
The objective of this work, in patients who underwent a total gastrectomy for gastric cancer, is to investigate the mortality rates at 30 days and 90 days, also collecting factors associated with deaths in this last period.
| Materials and methods |
Retrospective analysis was performed using the National Cancer Database (2004-2015). Adult patients (18 years of age or older) who underwent total gastrectomy for stage I to III gastric adenocarcinoma were identified and divided into cohorts based on 90-day mortality. To mitigate the impact of delay in definitive treatment, patients who underwent definitive surgical resection >365 days after diagnosis were excluded.
Patient variables evaluated included age, sex, race, income above or below the median level, insurance type, and Charlson-Deyo score.
Predictors of mortality were analyzed using multivariable logistic regression, and annual trends in mortality rates were calculated using Joinpoint regression.
| Results |
Of the 5,484 patients who underwent total gastrectomy, the 90- and 30-day mortality rates were 9.1% and 4.7%, respectively. The median age of the entire cohort was 66 years.
Factors associated with 90-day mortality included increasing age, income below the median level, Charlson-Deyo score -2, treatment in low-volume facilities having stage N1, stage N2 or N3, with <16 lymph nodes removed, and lack of chemotherapy treatment. Lack of health insurance and positive microscopic margins were correlated, but not significantly associated, with 90-day mortality.
Lack of health insurance and positive microscopic resection margins were correlated with increased 90-day mortality, although these associations were not statistically significant.
The 90-day mortality rate decreased significantly from 14.3% in 2004 to 7.9% in 2015 and the 30-day mortality rate decreased significantly from 7.7% in 2004 to 4.8% in 2015. .
| Discussion |
Although previous studies have demonstrated appreciable morbidity and mortality within the immediate 30-day postoperative period after total gastrectomy, less effort has been focused on describing 90-day mortality for this procedure, although evidence from other cancer types has shown that mortality within this period may be a superior metric for evaluating patients undergoing major oncologic resections.
The present study shows that the annual 90- and 30-day mortality rates, as well as the average length of postoperative stay, appear to be decreasing in patients undergoing total gastrectomy for gastric cancer. However, it is essential to note that, despite this improvement, 90-day mortality is still almost double that of 30-day mortality.
Furthermore, the finding that the majority of patients in this study who had 90-day mortality had been discharged before they died indicates that there is a significant opportunity for improvement in reducing late mortality among discharged patients. . Lower socioeconomic status may be a major contributing factor, as patients with below-median income and no insurance were more likely to die at 3 months in this study.
In particular, this analysis found that the type of surgical approach performed was not a factor significantly associated with 90-day mortality in patients undergoing total gastrectomy for gastric cancer.
Although a minimally invasive approach has been associated with significantly lower morbidity, including less intraoperative blood loss, earlier recovery of bowel function, shorter hospital stay, and comparable oncologic outcomes to an open approach, the association between a laparoscopic approach and higher mortality in patients undergoing gastrectomy for gastric cancer is less clear.
Conclusions
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