P-100 - The Rhesus D - negative phenotype is one of the major risk factors for postoperative complications after gastrectomy for gastric carcinoma

Date 04 July 2015
Event WorldGI 2015
Session Posters
Topics Complications of Treatment
Gastric Cancer
Surgery and/or Radiotherapy of Cancer
Presenter A. Baušys
Citation Annals of Oncology (2015) 26 (suppl_4): 1-100. 10.1093/annonc/mdv233
Authors A. Baušys1, D. Klimas1, A. Kilius2, K. Pauža2, G. Rudinskaite˙2, Ž. Sinkevičius2, N. Samalavičius2, E. Sangaila2, R. Baušys2
  • 1Faculty of Medicine, Vilnius/LT
  • 2National Cancer Institute, Vilnius/LT

Abstract

Introduction

Some studies have identified Rhesus D- negative phenotype as an important independent risk factor for survival in gastric cancer patients who underwent curative resection, but the influence of this factor for short term results after gastric surgery for gastric cancer is still questionable. The aim of our study was to identify if RhD– negative phenotype is a risk factor for postoperative complications after gastrectomy.

Methods

All patients who underwent total and subtotal gastrectomy for gastric cancer in National Cancer Institute between 2013–2014 were retrospectively analyzed. Postoperative mortality and morbidity rate were estimated. Postoperative complications were classified according to Clavien – Dindo classification. Medical records were reviewed and the following factors were extracted and entered into a database: age, gender, smoking, alcoholism, body mass index (BMI), blood group according to AB0 and RhD antigens, comorbidity, American Society of Anesthesiologist (ASA) classification, tumor size, distant metastasis, number of removed and involved lymph nodes, tumor differentiation grade, lymphovascular invasion, type of surgery, length of surgery, multiorgan resection, intraoperative blood loss, neoadjuvant chemotherapy and preoperative count of WBC, RBC, PLT, urea, creatinine, protein, albumin, glucose, K, Na, CL. Non-parametric tests and linear multiple regression models were used for statistical analysis.

Results

229 patients were included in this study, mean age was 66,43 ± 12,07, and 61% were male. Postoperative mortality and morbidity rate were respectively 2,6% and 36,7%. Elderly age (>70 yr), higher number of removed (23,77 vs 29,02, p < 0,05) and involved lymph nodes (4,76 vs 9,30, p < 0.05), higher intraoperative blood loss (158,87 ml vs 271,08 ml, p < 0.05), longer length of surgery (164 min. vs 173 min., p < 0.05), lower level of serum hemoglobin (145 g/l vs 84 g/l, p < 0.05) and albumin (44,07 g vs 41,45 g, p<0.05), ASA score > 2 (26,2% vs 50%, p < 0.05), RhD – negative phenotype (29,7% vs 50%, p < 0.05), lymphovascular invasion (33% vs 46,6%, p < 0.05), advanced stage of disease (I-24,3%, II-28,6%, III-45%, IV-56,2%, p < 0.05), total gastrectomy (33% vs 46,6%), multiorgan resection (34% vs 57,7%, p < 0,05) were significantly associated with higher complication rate. Multivariate analysis identified RhD – negative phenotype (OR = 2,88, 95% CI 1,27-6,55, p < 0.05) and intraoperative blood loss more than 300 ml (OR = 4,74, 95% CI 1,24-18,11) as independent risk factors for higher complication rate after gastric surgery for gastric cancer.

Conclusion

This study provided additional information about the factors associated with higher complication rate after gastrectomy for gastric cancer. We identified RhD – negative phenotype as an independent risk factor for higher postoperative morbidity. After study was conducted RhD – negative phenotype could be associated not only with worse long term results, but also with worse short term results of surgical gastric cancer treatment.