Risk factors for surgical treatment in the Dutch gastric cancer trial

Abstract

BACKGROUND: A multicentre randomized study of surgical treatment of gastric cancer has shown increased mortality and morbidity rates in patients having D2 resection. The aim of this report is to analyse risk factors in these patients. METHODS: In a prospective randomized trial, comparing two types of lymphadenectomy for curable gastric cancer, risk factors for hospital death and morbidity in 711 patients treated with curative intent were evaluated by multivariate analysis using stepwise regression analysis. RESULTS: Age greater than 65 years and male sex were the most important risk factors for death (relative risk (RR) 4.35 (95 per cent confidence interval (c.i.) 2.07-9.15) and 2.51 (95 per cent c.i. 1.24-5.08) respectively). The extent of nodal dissection was also a significant risk factor for death (RR 2.13). For overall complications, splenectomy was the most important risk factor (RR 2.13 (95 per cent c.i. 1.44-3.16)), while pancreatectomy and type of gastrectomy were the only factors significantly influencing the occurrence of major surgical complications. CONCLUSION: The cumulative mortality risks of these factors should be considered carefully when planning surgery for individual patients.