Stomach cancer elective surgery morbidity and mortality at 90-Day (Hold Study): a prospective, international collaborative cohort study

Neves-Marques, Claudia, Abulazayem, Mohamed, Wong, Geoffrey Yuet Mun, Maldonado, Ricardo David, Viswanath, Yirupaiahgari, Boddy, Alex, Donohoe, Claire, Scarano, Juan Pablo, Martinino, Alessandro, Aamery, Amaar, Abdulkhakimov, Nuriddin, Abuobaida, Essam Eldien, Aday, Ulaş, Al-Shami, Khayry, Alhajami, Faris, Almeida, Ana, Almoshantaf, Mohammad Badr, Ahmed, Hassan, Andrada, Martín, Anwer, Abdul Wahid, Awad, Ahmed K., Baili, Efstratia, Baraket, Oussama, Barbosa, José, Baker, Cara, Bakri, Ashraf, Boras, Zdenko, Caiado, André, Cayirci, Can, Calini, Giacomo, Cianci, Pasquale, Cinal, Esin, Chouliaras, Christos, Colak, Elif, Correia, Maria Teresa, Costeira, Beatriz, Davletshina, Viktoria, D’Acapito, Fabrizio, Donmez, Turgut, Drozdov, Evgeniy, Ercolani, Giorgio, Erdene, Sarnai, Erginöz, Ergin, Ferreira, Samantha Rocha, Fragoso, Marta, Framarini, Massimo, Galandarova, Aysuna, Genser, Laurent, Gorohov, Ilya, Grosek, Jan, Guerrero, Silvia, Hasırcı, Ismail, Ibrahimli, Arturan, Ithurralde-Argerich, Javier, Karabulut, Mehmet, Kinoshita, Takahiro, Khalid, Ibtissam Bin, Khan, Khurram, Khattak, Shahid, Khomyakov, Vladimir, Krawczyk, Wiktor, Khamees, Almu’atasim, Kostrygin, Alexander, Košir, Jurij, Lorenc, Zbigniew, Milhomem, Jorge, Marom, Gadi, Melo, Ana, Menasria, Abdelkader, Meric, Serhat, Mulita, Francesk, Muratore, Andrea, Omarov, Taryel, Palomba, Giuseppe, Paul, Negine, Pathak, Akshant, Pavone, Giovanna, Pavlov, Rostislav, Pinillla, Raul, Rasheed, Omeed, Remini, Anouar, Ryabov, Andrey, Samadov, Elgun, Samarasam, Inian, Sandag, Erdene, Santos, Jorge, Sanchez, Elio, Saroglu, Azize, Schizas, Dimitrios, Serralheiro, Pedro Azevedo, Simsek, Oguzhan, Sobolev, Dmitry, Souadka, Amine, de Sousa, José Vieira, Sousa, Fabiana, Suer, Muhammed, Surendran, Suraj, Syllaios, Athanasios, Syed, Aamir Ali, Terajima, Daiki, Tokocin, Merve, Triantafyllou, Tania, Uludağ, Server, Uprak, Tevfik, Vaz, Susan, Vecchiato, Massimo, Verras, Georgios Ioannis, Veroux, Massimiliano, Voon, Kelvin, Vovin, Kirill, Yacob, Myla, Walędziak, Maciej, Zacharenko, Alexander, Zahara, Fatima Tu, Singhal, Rishi and Mahawar, Kamal (2025) Stomach cancer elective surgery morbidity and mortality at 90-Day (Hold Study): a prospective, international collaborative cohort study. Langenbeck's Archives of Surgery, 411 (1): 12. p. 12. ISSN 1435-2451

Item Type:	Article

Abstract

Background: Data on multinational 90-day mortality and morbidity rates after surgery for gastric cancer is limited in the literature. This study aimed to understand the 90-day mortality and morbidity outcomes among patients undergoing elective gastric cancer surgery, as in the GASTRODATA Registry, and to identify associated risk factors. Methods: We conducted an international prospective study on patients aged ≥ 18 years undergoing elective surgery for gastric cancer with curative intent from January 4 to September 30, 2022. Known metastatic disease, concurrent secondary cancers, gastrointestinal stromal tumour (GIST) and Siewert type I/II oesophagogastric junction malignancies were excluded. Univariate and multivariate logistic regression were used to identify variables associated with the 90-day outcome. Results: 380 collaborators from 47 countries submitted data on 1538 patients. Median age was 65 years (IQR: 19–94), and 58.5% were males. 90-day morbidity and mortality rates were 38.2% (n = 587) and 2.9% (n = 45), respectively. Pre-operative higher Charlson Comorbidity Index, higher ASA score, pre-operative weight loss > 10%, positive specimen margin, and post-operative pathological IV staging (p value < 0.05) were significantly associated with clinically relevant complications and mortality. Conclusion: Elective gastric cancer surgery has a 90-day morbidity of 38.2% and a 90-day mortality of 2.9% globally. This study provided the most comprehensive international 90-day prospective data to date regarding gastric cancer surgery. Several factors associated with higher morbidity were identified, highlighting the importance of a unified language on surgical morbidity, prehabilitation, and ongoing audits to enhance patient outcomes.

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Additional Information: ** From Springer Nature via Jisc Publications Router ** History: received 03-01-2025; registration 22-09-2025; accepted 22-09-2025; epub 14-11-2025; online 14-11-2025; collection 01-12-2026. ** Licence for this article: http://creativecommons.org/licenses/by/4.0/ ** Acknowledgements: HOLD Study Collaborative Group: Ahmed M. Abbas, Imed Abbassi, Ibrahim Abdelhamid, Federico Abente, Haider Abid, Ayman Abouleid, Hans Débora Acín-Gándara, Ademola A Adeyeye, Alaa Mohamed Ads, Nezih Akkapulu, Talar Vartanoglu Aktokmakyan, Sergei Aksenov, Peter Ikponmwosa Agbonrofo, Mosheer S. Al-Dahdouh, Nigar Allahverdiyeva, Manar Al-Shami, Zaid Al-Sheikh Ali, Rawan Mohammed Al-Sallal, Ahmad Malek Alsheikh, Hamza Al-Naggar, Aiman Allawgalli, Subhi Zahi Al-Issawi, Sief-Addeen Al-Tahayneh, Michele Ammendola, Ahmed Y Ammar, Laila Amrani, Mario Annecchiarico, Elissavet Anestiadou, Luciano Antozzi, Giovanni Aprea, Giulio Argenio, Akif Enes Arikan, Alan Askari, Alberto Assisi, Nora Ra'ed Atiah, Selmy S Awad, Karim Ayed, Kemal Arslan, Jean-Baptiste Bachet, Juan Balcazar, Vignesh Bala, Guillermo Ponce De Leon Ballesteros, Christina D Bali, Andrea Balla, Laura E R Barbosa, Stefano Bartolomeo, Raffaele Basile, Nurur Bayramov, Aparna Govil Bhasker, Usman M Bello, Zakaria Houssain Belkhadir, Mahesh Bendemagal, Amine Benkabbou, Solomon Bera, Antonio Jose Bernardes, Patrícia Bernardo, Federica Bianco, Stefanos Bitsianis, Joana S Bolota, Alessandro Bonomi, Nuno Borges, Haktan Övül Bozkır, El Ahmadi Brahim, Vittorio Bresadola, Marcos Bruna, Andrew D Bueno, Virginia Cano Busnelli, Rasika Bulathsinhela, Francisco Cabral, Marcello Calabrò, Emir Capkinoglu, Marianna Capuano, Constantino Fondevila Campo, Salvatore Carrabetta, Clifford Caruana, Rui Casaca, Federico Del Castillo-Díez, Fausto Catena, Danilo Centonze, Anna Chaika, Alexandros Charalabopoulos, Aishwarya Chokshi, Lynn Chong, Christian Cotsoglou, Daniel M Chircop, Sharfuddin Chowdhury, Beatriz Chumbinho, Sudhakar Chandran, Leonardo Luca Chiarella, Ivana Conversano, Paulo M. Costa, Gangalakshmi Chokkalingam, Liliana Cuevas, Jan Giuseppe Currò, Noureddine Chadli, Vladica V Ćuk, Giovanni Dapri, Dragomir Dardanov, Anuj Dash, Gabriel Mihail Dimofte, Andrew R Davies, Angel Diaz, Agron Dogjani, Onur Dülgeroğlu, Agustin Duro, Anne Sophie Dulac, Mohammed Hisham Eid, Hosam Elghadban, Nagm Eldin Abu Elnga, Mohamad Elfawal, Hazebroek Eric, Giuseppe Evola, Sarah K. Fahmi, Alice Filippelli, Yuri Fishman, Muratcan Fırat, Matthew Forshaw, Aakash Fouzdar, Francesco Frattini, Joana R Frazão, Lewis S Gall, Luca Casingena Garcia, Senthilkumar Ganesan, Ioannis Gerogiannis, Mohamed Hedi Ghalloussi, Elliot Goodman,James A Gossage, Stefano Granieri, Amit Gupta, Ashok R Gunawardene, Rahul Gupta, Hytham Hamid, Abdul Rahman Hammadieh, Joshua N Hammerschlag, Francisco J Henao, Rufino Eduardo Herrera, Michael W Hii, Samir Hosny, Joshua Hong, Nikolaos Intzes, Orestis Ioannidis, Omorodion Omoruyi Irowa, Ivaylo Ivanov, Rawia Jamal, Periyathambi Jambulingam, Mustafa A. Abu Jayyab, Alexander Julianov, Tatyana S Kalinina, Aziz Kamalov, Ahmad Amir H. Kayali, Mohd Kayyal, Vijay Kumar, Mandeep Kaur, Askar J Keen, Mark Kelly, Mohammad Kermansaravi, Guowei Kim, Michal Kisielewski, Mohamad Klib, Archana Khanduri, Mansoor Khan, Cheng Jing Khaw, Malak Khaled Khlouf, Karina Koreshkova, Bojan M Kovačević, Patricia M.P. Lages, Oumaima Lahnaoui, Larry Weng Hong Lai, Pedro Laranjo, Konstantinos Lasithiotakis, Lazarou Lazaros,Pasquale Lepiane, Georgios D Lianos, Alessio Licciardello, Corrado Da Lio, Gordon Liu, Sorinel Lunca, Andrea-Pierre Luzzi, Daniele Macchini, Annalisa Mancin, Mário S Marcos, Rita V Martins, Alexander Mahendran, Mohammed Anass Majbar, Marina Makurina, Rosa J Matias, Mustafa Sabri Massadi, Ruqaya Masri, Jean Mbonicura, Isabel M Mesquita, Milica A Milentijević, Migena Miza, Lourenço Moniz, Paolo Morgagni, Federico Moser, Adnan Mohammed, Raouf Mohsine, Cecília Monteiro, Isabella Mondi, Daniele Morezzi, Ana-Maria Musina, Areej Esam Nadeesh, Carlo Nagliati, Eddy Lincango Naranjo, Ayman Ibrahim Naser, Pueya Nashidengo, Aleksandr Neimark, Ionut Negoi, Prabhu N Nesargikar, Chiara Nessi, Elena Herranz Van Nood, Lucio Rircardo Obeide, Stefano Olmi, Joana Ip Oliveira, Susana S. Onofre, Steve-Nation Nehiweze Oriakhi, Mouaqit Ouadii, Mehmet Faik Özçelik, Zeynep Özdemir, Mahir Ozmen, Giovanni Domenico De Palma, Anshuman Pandey, Hugo Palmieri, Bernardo L Patrício, Caghan Peksen, Plamen Petkov, Enrico Pinotti, Gegam Pogosyan, Sjaak Pouwels, Alexandra Pupo, Aisha Qayum, Carlos Coello Quan, Paulo Ramos, Deepak Rajput, Shiv Rajan, Muhammad Shahan Raza, Matthew Read, Sofia Reis, Samuel E Rey, João G Ribeiro, Carolina Righetti, Cristian-Ene Roata, Emanuele Romairone, Homayoon Roshan, Laura Rosner, Elena Ruiz-Úcar, Antonio Santangelo, Catarina Rolo Santos, Amira Said, Alpaslan Şahin, Nasser Sakran, Kamil Salimzyanov, Federica Saraceno, Hitesh Sarda, Osman Anil Savas, Marah Ahmad Sawaftah, Mohammad Ahmad Sawaftah, Khaled Ahmad Sawaftah, Ahsan Shafiq, Azhar Shabbir, Amir Shariff, Franco Signorini, Theodoros A Sidiropoulos, Silvia Silva, Jimmy Bok Yan So, João Pinto De Sousa, Paulo A Soares, Leonardo Solaini, Eleftherios Spartalis, Michael Spartalis, Konstantinos Stratoulias, Duminda Subasinghe, Shankar Subbarayan, Aziz Sumer, Fjorenta Sulo, Savvas Symeonidis, Kimutai Ronoh Sylvester, Safwan Taha, Flavio Roberto Takeda, Athanasios Tampakis, Nicola Tartaglia, Abdallah R. Temerik, Nilanjana Tewari, Anisse Tidjane, Omar Tilioua, Charalampos Theodoropoulos, Aleš Tomažič, Carlos Toro-Huamanchumo, Alexandra Triantafyllou, Ioannis Tsikritzakis, Tyseer Median Tyseer, Fabio Tuminello, Fara Uccelli, Matteo Uccelli, Mehmet Eşref Ulutaş, Cihan Uras, Anna Utkina, Michail Vailas, Jean Christophe Vaillant,José I. Valenzuela, Carlo Vallicelli, Natalia Velenciuc, Daunia Verdi, Marlon A Vesga, João S Vieira, Nakul Viswanath Ivan Vlahovic, Samuel Wanjara, Ishaan Wazir, Zhuoqi Wei, Cacio Wietzycoski, Wojciech M. Wysocki, Bara’ Sami Yacoub, Wah Yang, Raghad Yousef Yassin, Ayşegül Yılmaz, David Yordanov, Kağan Zengin, Valentina Zucchini, Mauricio Zuluaga.

Uncontrolled Keywords: Patient safety, Gastric cancer, Multinational audit, Anastomotic leaks, 90-Day postoperative outcomes, Surgical Complications, Elective surgery, Morbidity and mortality

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Identifiers

Item ID: 19655

Identification Number: 10.1007/s00423-025-03890-7

ISSN: 1435-2451

URI: https://sure.sunderland.ac.uk/id/eprint/19655

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Date Deposited: 29 Nov 2025 14:58

Last Modified: 29 Nov 2025 14:58

Contributors

Author:	Claudia Neves-Marques
Author:	Mohamed Abulazayem
Author:	Geoffrey Yuet Mun Wong
Author:	Ricardo David Maldonado
Author:	Yirupaiahgari Viswanath
Author:	Alex Boddy
Author:	Claire Donohoe
Author:	Juan Pablo Scarano
Author:	Alessandro Martinino
Author:	Amaar Aamery
Author:	Nuriddin Abdulkhakimov
Author:	Essam Eldien Abuobaida
Author:	Ulaş Aday
Author:	Khayry Al-Shami
Author:	Faris Alhajami
Author:	Ana Almeida
Author:	Mohammad Badr Almoshantaf
Author:	Hassan Ahmed
Author:	Martín Andrada
Author:	Abdul Wahid Anwer
Author:	Ahmed K. Awad
Author:	Efstratia Baili
Author:	Oussama Baraket
Author:	José Barbosa
Author:	Cara Baker
Author:	Ashraf Bakri
Author:	Zdenko Boras
Author:	André Caiado
Author:	Can Cayirci
Author:	Giacomo Calini
Author:	Pasquale Cianci
Author:	Esin Cinal
Author:	Christos Chouliaras
Author:	Elif Colak
Author:	Maria Teresa Correia
Author:	Beatriz Costeira
Author:	Viktoria Davletshina
Author:	Fabrizio D’Acapito
Author:	Turgut Donmez
Author:	Evgeniy Drozdov
Author:	Giorgio Ercolani
Author:	Sarnai Erdene
Author:	Ergin Erginöz
Author:	Samantha Rocha Ferreira
Author:	Marta Fragoso
Author:	Massimo Framarini
Author:	Aysuna Galandarova
Author:	Laurent Genser
Author:	Ilya Gorohov
Author:	Jan Grosek
Author:	Silvia Guerrero
Author:	Ismail Hasırcı
Author:	Arturan Ibrahimli
Author:	Javier Ithurralde-Argerich
Author:	Mehmet Karabulut
Author:	Takahiro Kinoshita
Author:	Ibtissam Bin Khalid
Author:	Khurram Khan
Author:	Shahid Khattak
Author:	Vladimir Khomyakov
Author:	Wiktor Krawczyk
Author:	Almu’atasim Khamees
Author:	Alexander Kostrygin
Author:	Jurij Košir
Author:	Zbigniew Lorenc
Author:	Jorge Milhomem
Author:	Gadi Marom
Author:	Ana Melo
Author:	Abdelkader Menasria
Author:	Serhat Meric
Author:	Francesk Mulita
Author:	Andrea Muratore
Author:	Taryel Omarov
Author:	Giuseppe Palomba
Author:	Negine Paul
Author:	Akshant Pathak
Author:	Giovanna Pavone
Author:	Rostislav Pavlov
Author:	Raul Pinillla
Author:	Omeed Rasheed
Author:	Anouar Remini
Author:	Andrey Ryabov
Author:	Elgun Samadov
Author:	Inian Samarasam
Author:	Erdene Sandag
Author:	Jorge Santos
Author:	Elio Sanchez
Author:	Azize Saroglu
Author:	Dimitrios Schizas
Author:	Pedro Azevedo Serralheiro
Author:	Oguzhan Simsek
Author:	Dmitry Sobolev
Author:	Amine Souadka
Author:	José Vieira de Sousa
Author:	Fabiana Sousa
Author:	Muhammed Suer
Author:	Suraj Surendran
Author:	Athanasios Syllaios
Author:	Aamir Ali Syed
Author:	Daiki Terajima
Author:	Merve Tokocin
Author:	Tania Triantafyllou
Author:	Server Uludağ
Author:	Tevfik Uprak
Author:	Susan Vaz
Author:	Massimo Vecchiato
Author:	Georgios Ioannis Verras
Author:	Massimiliano Veroux
Author:	Kelvin Voon
Author:	Kirill Vovin
Author:	Myla Yacob
Author:	Maciej Walędziak
Author:	Alexander Zacharenko
Author:	Fatima Tu Zahara
Author:	Rishi Singhal
Author:	Kamal Mahawar