Postoperative Complications, Including Minor Complications, Worsen Prognosis After Laparoscopic Distal Gastrectomy for Gastric Cancer

Background/Aim: The relationship between postoperative complications and prognosis after laparoscopic distal gastrectomy (LDG) for gastric cancer (GC) remains controversial. This study evaluated this association using propensity score-matched analysis.

Patients and Methods: We analyzed data of 590 patients who underwent curative LDG for GC at five institutions between January 2018 and December 2024. Patients were categorized into non-complication and complication groups (non-CG and CG, respectively), with complications defined as Clavien–Dindo grade ≥II (CD ≥II). Minor complications were defined as CD grades I or II, and major complications were defined as CD grades ≥III. Propensity score matching (PSM) was performed using the following covariates: age, sex, body mass index, American Society of Anesthesiologists physical status, extent of lymph node dissection, reconstruction method, Japanese Classification of Gastric Carcinoma stage, neoadjuvant chemotherapy, and adjuvant chemotherapy. Survival curves were compared using the log-rank test, and multivariate analysis was performed using the Cox proportional hazard models.

Results: Overall incidence of postoperative complications (CD ≥II) was 14.9% (88/590 patients). After the PSM (85 pairs), the CG group had a significantly longer postoperative hospital stay than the non-CG group [median (range), 18 (7-110) days vs. 9 (5-18) days; p<0.001]. Five-year overall survival (OS) rate was 90.7% in the non-CG group and 70.4% in the CG group (p=0.009), and 5-year relapse-free survival rate was 87.7% in the non-CG group and 70.9% in the CG group (p=0.027). Multivariable analysis identified age ≥80 years, postoperative complications (CD ≥II), and lymph node metastasis (pN) as independent prognostic factors for OS.

Conclusion: Reducing the incidence of postoperative complications (CD ≥II) may improve prognosis in patients with GC undergoing LDG, contributing to better treatment strategies for GC.