Perioperative Risk of Palliative Gastrectomy in Advanced Gastric Cancer: A Nationwide Multicenter Analysis of Severe Complications and Mortality

Background: Palliative surgery is often considered for advanced stages of gastric cancer to reduce symptoms and improve quality of life; however, it is associated with considerable risks of postoperative complications and mortality. The aim of this study is to analyze the differences in severe complication rates and mortality between palliative and curative gastric cancer surgeries using data from a nationwide survey conducted by the Korean Gastric Cancer Association. Materials and Methods: Data from 12,420 patients who underwent gastric cancer surgery in 2019 were analyzed. Surgical procedures were categorized as total gastrectomies (TGs), distal gastrectomies (DGs), or bypass operations. Patients were divided into curative gastrectomy (CG, n = 12,114) and palliative surgery (PS, n = 306) groups. Postoperative complications were classified using the Clavien–Dindo (C-D) classification. Severe complications were defined as C-D grade IIIa or higher. Results: Compared with the CG group, the PS group had significantly higher rates of severe complications (10.2% vs. 4.8%, p < 0.001) and mortality (1.6% vs. 0.2%, p = 0.001). Leakage (3.9% vs. 1.3%, p = 0.001) and pancreatic fistula (1% vs. 0.2%, p = 0.036) were significantly more common in the PS group. When compared by resection extent, the PS group had higher severe complication rates than the CG group for DGs (13% vs. 3.8%, p < 0.001) and a higher mortality rate for TGs (3.3% vs. 0.3%, p = 0.006). Conclusions: Palliative gastric cancer surgeries are associated with significantly higher rates of severe complications and mortality than are curative surgeries. These findings emphasize the need for careful patient selection and thorough preoperative counseling when considering palliative gastric cancer surgery.