Preoperative Multivariate Prediction of Morbidity After Gastrectomy for Adenocarcinoma

Abstract
Background: Gastrectomy remains the only curative treatment for gastric cancer. However,surgical morbidity and mortality remains high. Our aim was to identify the risk factors thatdetermine operative morbidity and mortality and to describe a simple method for preoperativestratification of morbidity outcome. Methods: Retrospective review of patients who underwent gastrectomy for gastric cancer.Multivariate analysis was used to define risk factors for surgical morbidity and mortality. Results: A total of 208 cases were included. Fifty-one episodes of operative morbidity and 19surgery-related deaths were found. Operative blood loss (risk ratio [RR], 1.0012), serum albumin(RR, 0.42), extent of gastrectomy (RR, 2.8), lymphocyte count (RR, 0.999), and splenectomy (RR,1.51) were the most important risk factors for morbidity. However, location of the tumor, serumalbumin level, and lymphocyte count were the most important preoperative risk factors thatdetermine the appearance of surgical complications. Receiver operating characteristic analysis ofthis model allowed definition of three risk groups in terms of surgical morbidity (11.8%, 28.5%, and52.4%, respectively). Conclusions: A new method for preoperative calculation of the probability of surgical complicationswas developed. It must be validated prospectively and in different settings to be used inpreoperative interventions designed to reduce that risk.