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Postoperative Complications Adversely Affect Long-Term Survival of Patients With Adenocarcinoma of the Gastroesophageal Junction (GEJ)
Ian J. Tan^*, Kon Voi Tay, Wei Qi Leong, Amy Yuh Ling Tay, Mu Yar Soe, Wei-Peng Yong, Thiow Kong Ti, Asim Shabbir, Jimmy B. So
University Surgical Cluster, National University Health System, Singapore, Singapore, Singapore

Introduction
The impact of surgical complications on the survival of patients with GEJ cancers is controversial. Data from Asian centers is also limited.
Aim
To evaluate the operative outcomes and factors predicting survival of patients with GEJ adenocarcinoma who underwent surgery in our institution over the past 15 years.
Methods
Patients were selected from a prospective database of 881 patients with gastric carcinoma from 2001-2015. GEJ cancers were defined according to Siewert classification. Surgical complications (Clavien-Dindo classification) and survival were evaluated.
Results
85 patients with GEJ adenocarcinoma, mean age of 61(20-84yrs) and male predominance (82.4%) were identified. The proportion of Siewert Type 1, Type 2 and Type 3 cancers was 11.8%, 35% and 53% accordingly. 70(82.4%) and 13(15.3%) patients underwent surgery via trans abdominal and transthoracic approach respectively. Postoperatively, 21(24.7%) experienced Clavien grade III-V complications. 30-day mortality occurred in 2 patients (2.3%). Most patients (62.4%) were stage III or IV. Mean overall survival was 62(95% CI 45-79) months.
On multivariate analysis, patients with grade III-V complications (HR 4.19; 95% CI 2.01-8.70; p<0.01) and infective complications were associated with poorer survival (HR 1.10; 95% CI 0.53-2.31; p<0.01).
Conclusion
Siewert Type 1 GEJ cancers were relatively uncommon. Clavien Grade III-V postoperative complications and infective complications had a negative impact on the survival of patients with GEJ cancer

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