Increased Morbidity Rates in Patients With Heart Disease or Chronic Liver Disease Following Radical Gastric Surgery
ABSTRACT The aim of this study was to investigate possible associations between (i) comorbid disease and (ii) perioperative risk factors and morbidity following radical surgery for gastric cancer.
Consecutive patients (759) undergoing radical gastrectomy and D2 level lymph node dissection for gastric cancer were included. Clinical data concerning patient characteristics, operative methods, and complications were collected prospectively.
The morbidity rate for radical gastrectomy was 14.2% (108/759). The most significant comorbid risk factors for postoperative morbidity were heart disease [anticoagulant medication: OR = 1.5 (95% CI = 0.35-6.6, P = 0.53); history without medication: OR = 4.0 (95% CI = 1.1-14.6, P = 0.03); history with current medication: OR = 6.7 (95% CI = 1.5-29.9, P = 0.01)] and chronic liver disease [chronic hepatitis: OR = 2.4 (95% CI = 0.9-6.5, P = 0.07); liver cirrhosis class A: OR = 8.4 (95% CI = 2.8-25.3, P = 0.00); liver cirrhosis class B: OR = 9.38 (95% CI = 0.7-115.5, P = 0.08)]. The most significant perioperative risk factors for postoperative morbidity were high TNM stage and combined organ resection (P < 0.05), and there was no association between increased postoperative morbidity and well controlled hypertension, anticoagulant therapy, diabetes mellitus, pulmonary disease, tuberculosis, or thyroid disease (P > 0.05).
Patients with heart disease or chronic liver disease are at a higher risk of morbidity following radical surgery for gastric cancer.
SourceAvailable from: Mikito Inokuchi[Show abstract] [Hide abstract]
ABSTRACT: 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. 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). 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.BMC Surgery 11/2014; 14(1):97. DOI:10.1186/1471-2482-14-97 · 1.24 Impact Factor
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ABSTRACT: The prevalence of gastric cancer in the elderly is increasing. The purpose of this study was to clarify factors related to morbidity following gastric cancer surgery in elderly patients.09/2014; 14(3):173-9. DOI:10.5230/jgc.2014.14.3.173
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ABSTRACT: Abstract Background: Post-operative pulmonary complications (PPCs) negatively affect patients' quality of life and can be life-threatening. Predictors of PPCs have been evaluated in patients who underwent various operations, but few studies have specifically focused on gastrectomy. Methods: We retrospectively studied 1,053 patients with gastric adenocarcinoma who underwent radical gastrectomy with lymphadenectomy in our hospital between 1999 and 2011. Post-operative pulmonary complications were defined as conditions such as pneumonia, macroscopic atelectasis, pneumothorax, and acute respiratory distress syndrome that developed within 30 d after surgery. We evaluated the relations between PPCs and pre-operative or intra-operative factors and assessed risk factors for PPCs after gastrectomy. Result: A total of 49 (4.7%) patients had PPCs. On univariate analysis, PPCs were significantly associated with male gender (p=0.024), predicted vital capacity (VC) (p=0.020), a lower pre-operative serum albumin concentration (p=0.023), open surgery (p=0.007), total gastrectomy (p<0.001), combined resection of another organ (p=0.001), extended operating time (p<0.001), higher operative bleeding volume (p<0.001), intra-operative or post-operative blood transfusion (p=0.009), and pathologic tumor stage (p=0.003). On multivariable analysis, extended operating time (odds ratio [OR], 3.21, 95% confidence interval [CI] 1.46-7.07; p=0.004), total gastrectomy (OR, 2.65, 95% CI 1.25-5.59; p=0.011) and predicted VC (OR, 2.42, 95% CI 1.01-5.85; p=0.049) were independent risk factors. These three factors also were independent risk factors for post-operative pneumonia (total gastrectomy OR, 2.64, 95% CI 1.32-5.30; p=0.006); extended operating time OR, 2.54, 95% CI 1.24-5.19; p=0.011; and predicted VC OR, 2.41, 95% CI 1.01-5.75; p=0.048). Conclusion: Extended operating time, total gastrectomy, and predicted VC were independent predictors of PPCs, particularly pneumonia, in patients with gastric cancer who underwent gastrectomy. In patients with restrictive pulmonary dysfunction who are scheduled to undergo total gastrectomy, reduced lymphadenectomy or the avoidance of combined resection should be considered to shorten the operating time.Surgical Infections 05/2014; 15(3). DOI:10.1089/sur.2013.031 · 1.72 Impact Factor