Department of Surgery, Seoul National University College of Medicine, Seoul, Korea.
J Surg Oncol. 2010 Mar 1;101(3):200-4. doi: 10.1002/jso.21467.
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.
本研究旨在探讨胃癌根治性手术后（i）合并症和（ii）围手术期危险因素与发病率之间的可能关联。
连续纳入 759 例接受胃癌根治性胃切除术和 D2 水平淋巴结清扫术的患者。前瞻性收集患者特征、手术方法和并发症的临床数据。
根治性胃切除术的发病率为 14.2%（108/759）。术后发病率的显著合并症危险因素是心脏病[抗凝药物：OR=1.5（95%CI=0.35-6.6，P=0.53）；无药物史：OR=4.0（95%CI=1.1-14.6，P=0.03）；有药物史：OR=6.7（95%CI=1.5-29.9，P=0.01）]和慢性肝病[慢性肝炎：OR=2.4（95%CI=0.9-6.5，P=0.07）；A级肝硬化：OR=8.4（95%CI=2.8-25.3，P=0.00）；B 级肝硬化：OR=9.38（95%CI=0.7-115.5，P=0.08）]。术后发病率的显著围手术期危险因素是高 TNM 分期和联合器官切除术（P<0.05），而高血压、抗凝治疗、糖尿病、肺部疾病、结核病或甲状腺疾病得到良好控制与术后发病率增加之间无关联（P>0.05）。
心脏病或慢性肝病患者行胃癌根治性手术后发病率较高。
