Stomach cancer elective surgery morbidity and mortality at 90-Day (Hold Study): a prospective, international collaborative cohort study


Neves-Marques C., Abulazayem M., Wong G. Y. M., Maldonado R. D., Viswanath Y., Boddy A., ...More

Langenbeck's Archives of Surgery, vol.411, no.1, 2026 (SCI-Expanded, Scopus) identifier identifier

  • Publication Type: Article / Article
  • Volume: 411 Issue: 1
  • Publication Date: 2026
  • Doi Number: 10.1007/s00423-025-03890-7
  • Journal Name: Langenbeck's Archives of Surgery
  • Journal Indexes: Science Citation Index Expanded (SCI-EXPANDED), Scopus, BIOSIS, EMBASE, MEDLINE
  • Keywords: 90-Day postoperative outcomes, Anastomotic leaks, Elective surgery, Gastric cancer, Morbidity and mortality, Multinational audit, Patient safety, Surgical Complications
  • Hacettepe University Affiliated: Yes

Abstract

Background: Data on multinational 90-day mortality and morbidity rates after surgery for gastric cancer is limited in the literature. This study aimed to understand the 90-day mortality and morbidity outcomes among patients undergoing elective gastric cancer surgery, as in the GASTRODATA Registry, and to identify associated risk factors. Methods: We conducted an international prospective study on patients aged ≥ 18 years undergoing elective surgery for gastric cancer with curative intent from January 4 to September 30, 2022. Known metastatic disease, concurrent secondary cancers, gastrointestinal stromal tumour (GIST) and Siewert type I/II oesophagogastric junction malignancies were excluded. Univariate and multivariate logistic regression were used to identify variables associated with the 90-day outcome. Results: 380 collaborators from 47 countries submitted data on 1538 patients. Median age was 65 years (IQR: 19–94), and 58.5% were males. 90-day morbidity and mortality rates were 38.2% (n = 587) and 2.9% (n = 45), respectively. Pre-operative higher Charlson Comorbidity Index, higher ASA score, pre-operative weight loss > 10%, positive specimen margin, and post-operative pathological IV staging (p value < 0.05) were significantly associated with clinically relevant complications and mortality. Conclusion: Elective gastric cancer surgery has a 90-day morbidity of 38.2% and a 90-day mortality of 2.9% globally. This study provided the most comprehensive international 90-day prospective data to date regarding gastric cancer surgery. Several factors associated with higher morbidity were identified, highlighting the importance of a unified language on surgical morbidity, prehabilitation, and ongoing audits to enhance patient outcomes.