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.
"In a large multicenter based study on laparoscopic gastrectomy, Kim et al.  investigated the operative risk presented by different comorbidity types and found that pulmonary disease was significantly associated with postoperative morbidity. On the other hand, several other studies have concluded that pulmonary disease did not significantly increase the risk of postoperative complications after gastric cancer surgery [14,15]. Because pulmonary disease is seldom clinically diagnosed unless overt respiratory symptoms develop, preoperative screening of pulmonary disease simply based on history taking or previous medical history might have inconsistent predictive value for postoperative morbidity. "
[Show abstract][Hide abstract] ABSTRACT: We evaluated the predictive value of preoperative lung spirometry test for postoperative morbidity and the nature of complications related to an abnormal pulmonary function after gastric cancer surgery.
Between February 2009 and March 2010, 538 gastric cancer patients who underwent laparoscopic (n = 247) and open gastrectomy (n = 291) were divided into the normal (forced expiratory volume in 1 second [FEV(1)]/forced vital capacity [FVC] ≥ 0.7, n = 441) and abnormal pulmonary function group (FEV(1)/FVC < 0.7, n = 97), according to the preoperative lung spirometry test. The predictive value of lung spirometry for postoperative morbidity was evaluated using the univariate and multivariate analysis.
After surgery, the abnormal pulmonary function group showed a significantly increased incidence of local (29.9% vs. 18.1%, P = 0.009) and systemic complications (8.2% vs. 2.0%, P = 0.005) than the normal group. Of local complications, anastomosis leakage and wound complication were found to be more common in the abnormal pulmonary function group. In the univariate and multivariate analysis, an abnormal pulmonary function was an independent predictor for postoperative local complication (odds ratio, 1.75; 95% confidence interval, 1.03 to 2.97) after adjusted by old age, total gastrectomy, open surgery, and tumor-node-metastasis stage. Meanwhile, an old age and a history of pulmonary disease were independent predictors for systemic complication.
Preoperative lung spirometry is a simple and useful means to predict postoperative morbidity after gastric cancer surgery. In view of its simplicity and low cost, we recommend adding preoperative lung spirometry test to assess the operative risk and aid in proper perioperative treatment planning.
Journal of the Korean Surgical Society 01/2013; 84(1):18-26. DOI:10.4174/jkss.2013.84.1.18 · 0.73 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Emergency operations for perforated peptic ulcer are associated with a high incidence of postoperative complications. While several studies have investigated the impact of perioperative risk factors and underlying diseases on the postoperative morbidity after abdominal surgery, only a few have analyzed their role in perforated peptic ulcer disease. The purpose of this study was to determine any possible associations between postoperative morbidity and comorbid disease or perioperative risk factors in perforated peptic ulcer.
In total, 142 consecutive patients, who underwent surgery for perforated peptic ulcer, at a single institution, between January 2005 and October 2010 were included in this study. The clinical data concerning the patient characteristics, operative methods, and complications were collected retrospectively.
The postoperative morbidity rate associated with perforated peptic ulcer operations was 36.6% (52/142). Univariate analysis revealed that a long operating time, the open surgical method, age (≥60), sex (female), high American Society of Anesthesiologists (ASA) score and presence of preoperative shock were significant perioperative risk factors for postoperative morbidity. Significant comorbid risk factors included hypertension, diabetes mellitus and pulmonary disease. Multivariate analysis revealed a long operating time, the open surgical method, high ASA score and the presence of preoperative shock were all independent risk factors for the postoperative morbidity in perforated peptic ulcer.
A high ASA score, preoperative shock, open surgery and long operating time of more than 150 minutes are high risk factors for morbidity. However, there is no association between postoperative morbidity and comorbid disease in patients with a perforated peptic ulcer.
Journal of Gastric Cancer 03/2012; 12(1):26-35. DOI:10.5230/jgc.2012.12.1.26
[Show abstract][Hide abstract] ABSTRACT: The aim of this study is to review systematically morbidity and mortality after non-hepatic surgery in patients with liver cirrhosis.
Comprehensive searches were conducted in PubMed, Embase and the Cochrane Library for articles using the words: liver failure, hepatic insufficiency, liver cirrhosis, cirrhosis, cirrhotic, surgical procedures, operative complications, operative mortality, postoperative complications, surgical complication, surgical risk, hernia.
Forty-six articles were selected from 5247 included after the initial search. Level of evidence provided in the articles varied greatly. Non-hepatic surgery of patients with cirrhosis resulted in increased postoperative morbidity and mortality compared to similar surgery for non-cirrhotic patients. Cholecystectomy and umbilical and inguinal hernia correction were associated with the lowest increased morbidity and mortality while pancreatic surgery, cardiovascular, and trauma surgery correlated with the highest. The preoperative model for end stage liver disease (MELD) and Child-Turcotte-Pugh (CTP) scores appeared to be predictive of postoperative risks. Portal hypertension and surgery in the emergency setting were associated with extra increased mortality and morbidity rates.
This systematic review of the literature showed that in patients with liver cirrhosis who undergo non-hepatic surgery, postoperative morbidity and mortality rates varied greatly depending on severity of the cirrhosis and the surgical procedure. However, the majority of procedures can be safely performed in patients with low MELD scores or CTP A cirrhosis without portal hypertension.
Best practice & research. Clinical gastroenterology 02/2012; 26(1):47-59. DOI:10.1016/j.bpg.2012.01.010 · 3.48 Impact Factor
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