Clinical importance of American Society of Anesthesiologists physical status on postoperative severe complications and long-term survival after gastrectomy for gastric cancer

Background With the increase in gastric cancer among the elderly, gastrectomy is becoming more common even in patients with various comorbidities and poor general conditions. This study aimed to clarify the significance of the American Society of Anesthesiologists physical status (ASA-PS), as an indicator of a patient’s general condition, on postoperative complications and long-term survival.Methods We retrospectively analyzed 529 patients who underwent gastrectomy for gastric cancer. The clinical influence of ASA-PS on the severe postoperative complications and the survival outcomes were investigated.Results Our participants were classified into three groups: ASA-PS 1, 2 and 3 (n = 117, 334 and 78). Multivariate analysis identified age ≥ 75 and ASA-PS 3 as independent risk factors for Clavien–Dindo ≥ 3 complications (p = 0.012 and < 0.001). Kaplan–Meier analyses demonstrated that 5-year overall survival (OS) and recurrence-free survival significantly worsened sequentially from ASA-PS 1 to 3 (p < 0.001 and < 0.001). Multivariate analysis identified age ≥ 75 and ASA-PS 3, minimally invasive surgery, and pStage ≥ III as independently associated factors for 5-year OS. The negative impact of ASA-PS 3 on OS and cancer-specific survival (CSS) became more prominent in the patients with pStage I gastric cancer (p < 0.001 and 0.081 in pStage I and ≥ II [OS] and p = 0.001 and 0.470 in pStage I and ≥ II [CSS]).Conclusions Our findings indicated the negative impact of poor ASA-PS on the postoperative outcomes. The influence on the oncological outcomes was particularly prominent in pStage I gastric cancer.