Journal of Gastric Cancer

The Korean Gastric Cancer Association (대한위암학회)
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Factors Related to Morbidity in Elderly Gastric Cancer Patients Undergoing Gastrectomies

  • Shin, Ha Song (Department of Surgery, Haeundae Paik Hospital, Inje University College of Medicine) ;
  • Oh, Sung Jin (Department of Surgery, Haeundae Paik Hospital, Inje University College of Medicine) ;
  • Suh, Byoung Jo (Department of Surgery, Haeundae Paik Hospital, Inje University College of Medicine)
  • Received : 2014.08.05
  • Accepted : 2014.08.22
  • Published : 2014.09.30
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Abstract

Purpose: 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. Materials and Methods: For this study, data from 411 patients who underwent curative gastrectomies with lymph node dissections between March 2010 and January 2013 were retrospectively studied using a prospectively designed database. Patients were divided into 2 groups (<70 years vs. ${\geq}70$ years). For each group, perioperative factors were analyzed to determine if they were associated with postoperative morbidity and mortality. Results: Comorbidities were more prevalent in the elderly group (${\geq}70$ years). Intraoperative and postoperative transfusions were also more frequently required in the elderly group. There was no significant difference in the number of retrieved lymph nodes between the 2 groups (44.3 vs. 46.6 nodes). In a comparison of the elderly versus non-elderly groups, the postoperative morbidity rates were 22.7% versus 8.9% (P<0.001) and the postoperative mortality rates were 4.2% versus 0% (P=0.002), respectively. Of the possible non-surgical complications, pulmonary problems were predominately found in the elderly group (P<0.001). Surgical complications were evenly distributed between the 2 groups (P=0.463). Postoperative morbidity was significantly associated with older age and postoperative transfusion. Multivariate analysis showed that higher body mass index (BMI) and postoperative transfusion were important factors associated with postoperative complications in the elderly group. Conclusions: Pulmonary complications were frequently problematic in elderly patients. Higher BMI and postoperative transfusion were significant risk factors for postoperative complications in elderly patients with gastric cancer.

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References

  1. Statistics Korea. Korean statistical information service [Internet]. Daejeon, Statistics Korea; [cited 2012 may 1]. Available from: http://Kosis.kr.
  2. Bonenkamp JJ, Songun I, Hermans J, Sasako M, Welvaart K, Plukker JT, et al. Randomised comparison of morbidity after D1 and D2 dissection for gastric cancer in 996 Dutch patients. Lancet 1995;345:745-748. https://doi.org/10.1016/S0140-6736(95)90637-1
  3. Cuschieri A, Fayers P, Fielding J, Craven J, Bancewicz J, Joypaul V, et al. Postoperative morbidity and mortality after D1 and D2 resections for gastric cancer: preliminary results of the MRC randomised controlled surgical trial. The Surgical Cooperative Group. Lancet 1996;347:995-999. https://doi.org/10.1016/S0140-6736(96)90144-0
  4. Park DJ, Lee HJ, Kim HH, Yang HK, Lee KU, Choe KJ. Predictors of operative morbidity and mortality in gastric cancer surgery. Br J Surg 2005;92:1099-1102. https://doi.org/10.1002/bjs.4952
  5. Kim HH, Han SU, Kim MC, Hyung WJ, Kim W, Lee HJ, et al. Long-term results of laparoscopic gastrectomy for gastric cancer: a large-scale case-control and case-matched Korean multicenter study. J Clin Oncol 2014;32:627-633. https://doi.org/10.1200/JCO.2013.48.8551
  6. Jeong SH, Ahn HS, Yoo MW, Cho JJ, Lee HJ, Kim HH, et al. Increased morbidity rates in patients with heart disease or chronic liver disease following radical gastric surgery. J Surg Oncol 2010;101:200-204.
  7. Kim W, Song KY, Lee HJ, Han SU, Hyung WJ, Cho GS. The impact of comorbidity on surgical outcomes in laparoscopyassisted distal gastrectomy: a retrospective analysis of multicenter results. Ann Surg 2008;248:793-799. https://doi.org/10.1097/SLA.0b013e3181887516
  8. Sobin LH Gospodarowicz MK, Wittekind C; International Union against Cancer, eds. TNM Classification of Malignant Tumours. 7th ed. Oxford: Wiley-Blackwell, 2009.
  9. Winslet MC, Mohsen YM, Powell J, Allum WH, Fielding JW. The influence of age on the surgical management of carcinoma of the stomach. Eur J Surg Oncol 1996;22:220-224. https://doi.org/10.1016/S0748-7983(96)80006-0
  10. Maehara Y, Emi Y, Tomisaki S, Oshiro T, Kakeji Y, Ichiyoshi Y, et al. Age-related characteristics of gastric carcinoma in young and elderly patients. Cancer 1996;77:1774-1780. https://doi.org/10.1002/(SICI)1097-0142(19960501)77:9<1774::AID-CNCR3>3.0.CO;2-C
  11. Benhamiche AM, Faivre J, Tazi AM, Couillault C, Villing AL, Rat P. Time trends in diagnostic strategy, treatment, and prognosis of gastric cancer in the elderly: a population based study. Eur J Cancer Prev 1997;6:71-77. https://doi.org/10.1097/00008469-199702000-00011
  12. Crews DE, Zavotka S. Aging, disability, and frailty: implications for universal design. J Physiol Anthropol 2006;25:113-118. https://doi.org/10.2114/jpa2.25.113
  13. Oohara T, Johjima Y, Yamamoto O, Tohma H, Kondo Y. Gastric cancer in patients above 70 years of age. World J Surg 1984;8:315-320. https://doi.org/10.1007/BF01655062
  14. Takeda J, Tanaka T, Koufuji K, Kodama I, Tsuji Y, Kakegawa T. Gastric cancer surgery in patients aged at least 80 years old. Hepatogastroenterology 1994;41:516-520.
  15. Otsuji E, Fujiyama J, Takagi T, Ito T, Kuriu Y, Toma A, et al. Results of total gastrectomy with extended lymphadenectomy for gastric cancer in elderly patients. J Surg Oncol 2005;91:232-236. https://doi.org/10.1002/jso.20330
  16. Wu CW, Lo SS, Shen KH, Hsieh MC, Lui WY, P'eng FK. Surgical mortality, survival, and quality of life after resection for gastric cancer in the elderly. World J Surg 2000;24:465-472. https://doi.org/10.1007/s002689910074
  17. Kunisaki C, Makino H, Takagawa R, Oshima T, Nagano Y, Ono HA, et al. Efficacy of laparoscopy-assisted distal gastrectomy for gastric cancer in the elderly. Surg Endosc 2009;23:377-383. https://doi.org/10.1007/s00464-008-9949-1
  18. Coniglio A, Tiberio GA, Busti M, Gaverini G, Baiocchi L, Piardi T, et al. Surgical treatment for gastric carcinoma in the elderly. J Surg Oncol 2004;88:201-205. https://doi.org/10.1002/jso.20153
  19. Lee SR, Kim HO, Yoo CH. Impact of chronologic age in the elderly with gastric cancer. J Korean Surg Soc 2012;82:211-218. https://doi.org/10.4174/jkss.2012.82.4.211
  20. Kim EJ, Seo KW, Yoon KY. Laparoscopy-assisted distal gastrectomy for early gastric cancer in the elderly. J Gastric Cancer 2012;12:232-236. https://doi.org/10.5230/jgc.2012.12.4.232
  21. Sharma KC, Brandstetter RD, Brensilver JM, Jung LD. Cardiopulmonary physiology and pathophysiology as a consequence of laparoscopic surgery. Chest 1996;110:810-815. https://doi.org/10.1378/chest.110.3.810
  22. Katai H, Sasako M, Sano T, Fukagawa T. Gastric cancer surgery in the elderly without operative mortality. Surg Oncol 2004;13:235-238. https://doi.org/10.1016/j.suronc.2004.09.007
  23. Endo S, Yoshikawa Y, Hatanaka N, Tominaga H, Shimizu Y, Hiraoka K, et al. Treatment for gastric carcinoma in the oldest old patients. Gastric Cancer 2011;14:139-143. https://doi.org/10.1007/s10120-011-0022-8
  24. Takeshita H, Ichikawa D, Komatsu S, Kubota T, Okamoto K, Shiozaki A, et al. Surgical outcomes of gastrectomy for elderly patients with gastric cancer. World J Surg 2013;37:2891-2898. https://doi.org/10.1007/s00268-013-2210-7
  25. Raghavan M, Marik PE. Anemia, allogenic blood transfusion, and immunomodulation in the critically ill. Chest 2005;127:295-307. https://doi.org/10.1378/chest.127.1.295
  26. Bernard AC, Davenport DL, Chang PK, Vaughan TB, Zwischenberger JB. Intraoperative transfusion of 1 U to 2 U packed red blood cells is associated with increased 30-day mortality, surgical-site infection, pneumonia, and sepsis in general surgery patients. J Am Coll Surg 2009;208:931-937, 937.e1-2; discussion 938-9. https://doi.org/10.1016/j.jamcollsurg.2008.11.019
  27. Xenos ES, Vargas HD, Davenport DL. Association of blood transfusion and venous thromboembolism after colorectal cancer resection. Thromb Res 2012;129:568-572. https://doi.org/10.1016/j.thromres.2011.07.047
  28. Jung DH, Lee HJ, Han DS, Suh YS, Kong SH, Lee KU, et al. Impact of perioperative hemoglobin levels on postoperative outcomes in gastric cancer surgery. Gastric Cancer 2013;16:377-382. https://doi.org/10.1007/s10120-012-0196-8
  29. Mullen JT, Davenport DL, Hutter MM, Hosokawa PW, Henderson WG, Khuri SF, et al. Impact of body mass index on perioperative outcomes in patients undergoing major intraabdominal cancer surgery. Ann Surg Oncol 2008;15:2164-2172. https://doi.org/10.1245/s10434-008-9990-2
  30. Inagawa S, Adachi S, Oda T, Kawamoto T, Koike N, Fukao K. Effect of fat volume on postoperative complications and survival rate after D2 dissection for gastric cancer. Gastric Cancer 2000;3:141-144. https://doi.org/10.1007/PL00011708
  31. Smetana GW. Preoperative pulmonary evaluation. N Engl J Med 1999;340:937-944. https://doi.org/10.1056/NEJM199903253401207

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