The impact of preoperative CEA and CA 19-9 levels on early and late postoperative outcomes in patients undergoing laparoscopic gastrectomy for gastric adenocarcinoma

Aims: The prognostic value of preoperative serum tumor markers in gastric cancer remains controversial. This study aimed to evaluate the association of preoperative carcinoembryonic antigen (CEA) and carbohydrate antigen 19-9 (CA 19-9) levels with clinicopathological characteristics, postoperative outcomes, and overall survival in patients undergoing laparoscopic gastrectomy with D2 lymphadenectomy. Methods: This retrospective cohort study included patients who underwent laparoscopic gastrectomy with D2 lymphadenectomy for gastric cancer. Patients with stage IV disease or those who received neoadjuvant chemotherapy were excluded. Preoperative CEA and CA 19-9 levels were categorized according to standard cutoff values. Clinicopathological characteristics, postoperative complications, resection margin status, and overall survival were analyzed. Kaplan–Meier survival analysis and multivariate Cox and logistic regression models were used to identify independent predictors of outcomes. Results: A total of 126 patients were included. Elevated preoperative CEA and CA 19-9 levels were observed in 10.3% and 18.3% of patients, respectively. Elevated CA 19-9 levels were significantly associated with advanced tumor depth (T3–4), lymph node metastasis, and lymphovascular invasion, whereas CEA levels showed no significant association with clinicopathological features. Conversion to open surgery was required in 15 patients (11.9%). Major postoperative complications (Clavien–Dindo grade ≥III) occurred in 2.4% of patients and were independently associated with an ASA score ≥3. Multivariate analysis demonstrated that neither CEA nor CA 19-9 levels independently predicted postoperative complications or positive resection margins. During follow-up, 37 deaths were recorded. Overall survival did not differ significantly according to preoperative CEA or CA 19-9 levels. In multivariate Cox regression analysis, pathological stage III was the only independent predictor of overall survival. Conclusion: Preoperative CA 19-9 levels are associated with aggressive pathological features in gastric cancer but do not independently predict overall survival, postoperative morbidity, or resection margin status in patients undergoing laparoscopic gastrectomy with D2 lymphadenectomy. Serum tumor markers should be interpreted as indicators of tumor burden rather than independent prognostic factors.