Original Investigation |

Predictive Factors of Postoperative Mortality After Junctional and Gastric Adenocarcinoma Resection

William B. Robb, MD1; Mathieu Messager, MD1,2,3; Diane Goere, MD4; Virginie Pichot-Delahaye, MD5; Jeremie H. Lefevre, MD, PhD6; Damien Louis, MD7; Jérôme Guiramand, MD8; Kevin Kraft, MD9; Christophe Mariette, MD, PhD1,2,3; for the FREGAT Working Group–FRENCH
[+] Author Affiliations
1Department of Digestive and Oncological Surgery, University Hospital Claude Huriez, Regional University Hospital Center, Lille, France
2Faculty of Medicine, North of France University, Lille, France
3Team 5 “Mucins, Epithelial Differentiation, and Carcinogenesis,” Institut National de la Santé et de la Recherche Médicale, Unite Mixte de Recherche 837, Jean-Pierre Aubert Research Centre, Lille, France
4Department of Digestive Surgery, Gustave Roussy Institute, Villejuif, France
5Department of Digestive Surgery, Lyon University Hospital, Lyon, France
6Department of Digestive Surgery, St Antoine University Hospital, Paris, France
7Department of Digestive Surgery, Toulouse University Hospital, Toulouse, France
8Department of Digestive Surgery, Paoli Calmette Institute, Marseille, France
9Department of Digestive Surgery, Tours University Hospital, Tours, France
JAMA Surg. 2013;148(7):624-631. doi:10.1001/jamasurg.2013.63.
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Importance  Postoperative mortality after junctional and gastric adenocarcinoma resection remains a significant issue.

Objective  To identify factors predictive of mortality within 30 days of junctional and gastric adenocarcinoma resection in a large national multicenter cohort.

Design  A retrospective study collecting data from a multicenter database of patients who underwent resection for junctional and gastric adenocarcinoma from January 1, 1997, through January 31, 2010. A stepwise logistic regression model was built to identify, by multivariate analysis, variables independently predictive of 30-day postoperative mortality (POM).

Setting  Nineteen university teaching hospitals in France.

Participants  Two thousand six hundred seventy patients with available data.

Main Outcome Measures  The primary end point was POM. Secondary end points included (1) late mortality (30-90 days after resection) and (2) postoperative morbidity.

Results  One thousand eight hundred ninety-six patients (71.01%) had gastric adenocarcinoma and 774 (28.99%) had junctional tumors. Neoadjuvant treatment was given to 655 patients (24.53%), and 114 patients (4.27%) died within 30 days of surgery. Postoperative mortality was higher in patients who experienced grades III and IV toxic effects during neoadjuvant treatment compared with those who did not (8.7% vs 2.9%, respectively; P = .007). Multivariate analysis revealed metastatic disease at diagnosis (odds ratio, 9.13 [95% CI, 3.29-25.35]; P < .001) and poor tolerance of neoadjuvant treatment (3.33 [1.25-8.85]; P = .02) as being independently predictive of POM. Centers performing at least 10 resections per year were found to be protective against POM (odds ratio, 0.29 [95% CI, 0.12-0.72]; P = .008).

Conclusions and Relevance  This large national cohort study confirms that advanced disease heightens the risk of POM; centralization of junctional and gastric adenocarcinoma resection is warranted. The novel finding that grades III to IV toxic effects during neoadjuvant therapy increase POM has significant implications for decision making in this subgroup of patients.

Trial Registration  clinicaltrials.gov Identifier: NCT01249859

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