Impact of Child-Pugh score on surgical outcomes after distal gastrectomy and right hemicolectomy: a retrospective study from the Japanese National Clinical Database.

[BACKGROUND] The association between preoperative liver function and short-term outcomes after gastrointestinal cancer surgery is unknown. This study investigated the impact of Child-Pugh score-based preoperative liver dysfunction on short-term outcomes after distal gastrectomy and right hemicolectomy.

[MATERIALS AND METHODS] We included patients who underwent distal gastrectomy for gastric cancer or right hemicolectomy for colon cancer between 2018 and 2022 from the Japanese National Clinical Database. Patients were classified based on their Child-Pugh scores, and the association between Child-Pugh scores and short-term outcomes was assessed using multivariable logistic regression. Overall postoperative mortality and incidence of postoperative complications within 30 days (Clavien-Dindo Grade >III) were evaluated.

[RESULTS] A total of 104 905 distal gastrectomy and 62 775 right hemicolectomy cases were included. Overall surgery-related mortality increased to 31.8% and 20.7% and overall complication rate increased to 18.2% and 31% in patients with a Child-Pugh score of 9 who underwent distal gastrectomy and right hemicolectomy, respectively. Even after risk adjustment, those with a score of 9 had a significantly higher risk of surgical mortality than patients with a Child-Pugh score of 5 following distal gastrectomy [odds ratio (OR) 64.80, 95% confidence interval (CI) 23.64-177.65] and right hemicolectomy (OR 39.56, 95% CI 14.77-106.01).

[CONCLUSIONS] Surgical mortality and incidence of surgical complications were associated with the Child-Pugh score in a score-dependent manner. The Child-Pugh score effectively estimates postoperative risk in gastrointestinal cancer surgery. Special caution is needed for patients with poor liver function, especially those with higher Child-Pugh scores.