Risk Factors and Prognostic Significance of Severe Postoperative Complications After Curative Resection for Remnant Gastric Cancer: A Multicenter Retrospective Study

Remnant gastric cancer (RGC) is associated with higher surgical difficulty and poorer long-term outcomes than primary gastric cancer. However, the impact of postoperative complications on prognosis in RGC remains unclear. This retrospective, multicenter cohort study included 126 patients who underwent curative surgery for RGC across five institutions between 2007 and 2024. Postoperative complications were evaluated using the Clavien-Dindo (CD) classification. Patients were stratified into two groups based on the presence of severe complications (CD grade ≥ 3a). Logistic regression analysis was used to identify risk factors for complications, and Cox proportional hazards models were applied to determine prognostic factors for overall survival (OS) and recurrence-free survival (RFS). Severe postoperative complications occurred in 15.9% of patients. Multivariate analysis identified smoking (OR = 8.28, p = 0.0048), operative time ≥ 300 min (OR = 3.52, p = 0.0448), and blood transfusion (OR = 4.82, p = 0.0380) as independent risk factors for severe complications. Kaplan-Meier analysis demonstrated significantly poorer 5-year OS (32.0% vs. 65.6%, p = 0.002) and RFS (33.6% vs. 64.3%, p < 0.001) in patients with CD grade ≥ 3a complications. CD grade ≥ 3a and pathological Stage II or higher were independent prognostic factors for both OS and RFS. Severe postoperative complications are associated with poor long-term outcomes in patients undergoing curative surgery for RGC. Identifying and mitigating modifiable risk factors, such as smoking and operative invasiveness, may help improve surgical and oncological outcomes in this challenging population.