RISK-FACTORS FOR SURGICAL-TREATMENT IN THE DUTCH GASTRIC-CANCER TRIAL

Background A multicentre randomized study of surgical treatment of gas tric cancer has shown increased mortality and morbidity rates in patie nts having D-2 resection. The aim of this report is to analyse risk fa ctors in these patients.Methods In a prospective randomized trial, com paring two types of lymphadenectomy for curable gastric cancer, risk f actors for hospital death and morbidity in 711 patients treated with c urative intent were evaluated by multivariate analysis using stepwise regression analysis. Results Age greater than 65 years and male sex we re 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 ce nt c.i. 1.24-5.08) respectively). The extent of nodal dissection was a lso a significant risk factor for death (RR 2.13). For overall complic ations, splenectomy was the most important risk factor (RR 2.13 (95 pe r cent c.i. 1.44-3.16)), while pancreatectomy and type of gastrectomy were the only factors significantly influencing the occurrence of majo r surgical complications. Conclusion The cumulative mortality risks of these factors should be considered carefully when planning surgery fo r individual patients.