Impact of comorbidities on postoperative complications in patients undergoing laparoscopy-assisted gastrectomy for gastric cancer

被引:28
作者
Inokuchi, Mikito [1 ]
Kato, Keiji [1 ]
Sugita, Hirofumi [1 ]
Otsuki, Sho [1 ]
Kojima, Kazuyuki [2 ]
机构
[1] Tokyo Med & Dent Univ, Dept Surg Oncol, Tokyo, Japan
[2] Tokyo Med & Dent Univ, Dept Minimally Invas Surg, Tokyo, Japan
关键词
DISTAL GASTRECTOMY; RISK-FACTORS; PULMONARY COMPLICATIONS; MULTICENTER; MORBIDITY; SURGERY; IDENTIFICATION; VALIDATION; MORTALITY; OUTCOMES;
D O I
10.1186/1471-2482-14-97
中图分类号
R61 [外科手术学];
学科分类号
摘要
Background: Comorbidity is a predictor of postoperative complications (PCs) in gastrectomy. However, it remains unclear which comorbidities are predictors of PCs in patients who undergo laparoscopy-assisted gastrectomy (LAG). Clinically, insufficient lymphadenectomy (LND) is sometimes performed in high-risk patients, although the impact on PCs and outcomes remains unclear. Methods: We retrospectively studied 529 patients with gastric cancer (GC) who underwent LAG. PCs were defined as grade 2 or higher events according to the Clavien-Dindo classification. We evaluated various comorbidities as risk factors for PCs and examined the impact of insufficient LND on PCs in patients with risky comorbidities. Result: A total of 87 (16.4%) patients had PCs. There was no PC-related death. On univariate analysis, heart disease, central nervous system (CNS) disease, liver disease, renal dysfunction, and restrictive pulmonary dysfunction were significantly associated with PCs. Both liver disease and heart disease were significant independent risk factors for PCs on multivariate analysis (odds ratio [OR] = 3.25, p = 0.022; OR = 2.36, p = 0.017, respectively). In patients with one or more risky comorbidity, insufficient LND did not significantly decrease PCs (p = 0.42) or shorten GC-specific survival (p = 0.25). Conclusion: In patients who undergo LAG for GC, the presence of heart disease or liver disease is an independent risk factor for PC. Insufficient LND (for example, D1+ for advanced GC) might be permissible in high-risk patients, because although it did not reduce PCs, it had no negative impact on GC-specific survival.
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页数:8
相关论文
共 27 条
[1]   VALIDATION OF A COMBINED COMORBIDITY INDEX [J].
CHARLSON, M ;
SZATROWSKI, TP ;
PETERSON, J ;
GOLD, J .
JOURNAL OF CLINICAL EPIDEMIOLOGY, 1994, 47 (11) :1245-1251
[2]   Predictive factors for complications after pancreaticoduodenectomy [J].
Cheng, Qingbao ;
Zhang, Baihe ;
Zhang, Yongjie ;
Jiang, Xiaoqing ;
Zhang, Baohua ;
Yi, Bin ;
Luo, Xiangji ;
Wu, Mengchao .
JOURNAL OF SURGICAL RESEARCH, 2007, 139 (01) :22-29
[3]   Classification of surgical complications - A new proposal with evaluation in a cohort of 6336 patients and results of a survey [J].
Dindo, D ;
Demartines, N ;
Clavien, PA .
ANNALS OF SURGERY, 2004, 240 (02) :205-213
[4]   POSSUM and Its Related Models as Predictors of Postoperative Mortality and Morbidity in Patients Undergoing Surgery for Gastro-oesophageal Cancer: A Systematic Review [J].
Dutta, Sumanta ;
Horgan, Paul G. ;
McMillan, Donald C. .
WORLD JOURNAL OF SURGERY, 2010, 34 (09) :2076-2082
[5]   Estimates of worldwide burden of cancer in 2008: GLOBOCAN 2008 [J].
Ferlay, Jacques ;
Shin, Hai-Rim ;
Bray, Freddie ;
Forman, David ;
Mathers, Colin ;
Parkin, Donald Maxwell .
INTERNATIONAL JOURNAL OF CANCER, 2010, 127 (12) :2893-2917
[6]   A Multicenter Prospective Study of Surgical Audit Systems [J].
Haga, Yoshio ;
Ikejiri, Koji ;
Wada, Yasuo ;
Takahashi, Tadateru ;
Ikenaga, Masakazu ;
Akiyama, Noriyoshi ;
Koike, Shoichiro ;
Koseki, Masato ;
Saitoh, Toshihiro .
ANNALS OF SURGERY, 2011, 253 (01) :194-201
[7]   Risk Factors for Operative Complications in Elderly Patients During Laparoscopy-Assisted Gastrectomy [J].
Hwang, Sun-Hwi ;
Park, Do Joong ;
Jee, Ye Seob ;
Kim, Hyung-Ho ;
Lee, Hyuk-Joon ;
Yang, Han-Kwang ;
Lee, Kuhn Uk .
JOURNAL OF THE AMERICAN COLLEGE OF SURGEONS, 2009, 208 (02) :186-192
[8]  
Ichikawa D, 2004, HEPATO-GASTROENTEROL, V51, P613
[9]   Risk Factors for Post-Operative Pulmonary Complications after Gastrectomy for Gastric Cancer [J].
Inokuchi, Mikito ;
Kojima, Kazuyuki ;
Kato, Keiji ;
Sugita, Hirofumi ;
Sugihara, Kenichi .
SURGICAL INFECTIONS, 2014, 15 (03) :314-321
[10]  
Japanese Gastric Cancer Association, 2004, GASTR CANC TREATM GU, V2nd