Department of Esophagogastric Surgery, Tokyo Medical and Dental University, 1-5-45, Yushima, Bunkyo-ku, Tokyo, 113-8519, Japan.
Surg Endosc. 2013 Jun;27(6):2102-9. doi: 10.1007/s00464-012-2718-1. Epub 2013 Jan 11.
Laparoscopy-assisted gastrectomy (LG) is an established treatment for early gastric cancer. However, carbon dioxide pneumoperitoneum during laparoscopic surgery can adversely affect the pulmonary function of patients with chronic obstructive pulmonary disease (COPD). This retrospective cohort study was performed to assess the feasibility of LG for patients with COPD.
Among 1,053 patients who underwent radical gastrectomy with lymph node dissection between 1999 and 2011 at the authors' hospital, 220 patients with COPD were studied retrospectively. The clinical outcomes for the patients with COPD who underwent LG (LG group) were compared with those of COPD patients who underwent open gastrectomy (OG group), as well as those of patients with no operative risk and normal pulmonary function who underwent LG (NOR group). Postoperative pulmonary complications (PPCs) were defined as pneumonia, atelectasis, pneumothorax, prolonged mechanical ventilation (>24 h), and adult respiratory distress syndrome within 30 days after operation.
Pulmonary function variables were similar in the LG and OG groups. The findings showed PPCs to be slightly but not significantly less frequent in the LG group (1.7 %) than in the OG group (6.3 %) (p = 0.09). No difference in PPCs was found between the LG group and the NOR group (p > 0.99). For patients with COPD, advanced stage (stage 2 or 3 vs stage 1) was significantly associated with PPCs (p = 0.03), but was not an independent risk factor for PPCs (p = 0.12).
The LG procedure is tolerated in patients with gastric cancer who have mild or moderate COPD, similar to OG.
腹腔镜辅助胃切除术（LG）是治疗早期胃癌的一种成熟方法。然而，腹腔镜手术中的二氧化碳气腹会对慢性阻塞性肺疾病（COPD）患者的肺功能产生不利影响。本回顾性队列研究旨在评估 LG 治疗 COPD 患者的可行性。
在作者医院于 1999 年至 2011 年间接受根治性胃切除术和淋巴结清扫的 1053 例患者中，回顾性研究了 220 例 COPD 患者。将接受 LG 的 COPD 患者的临床结局（LG 组）与接受开腹胃切除术（OG 组）的 COPD 患者进行比较，并与无手术风险和正常肺功能的接受 LG 的患者（NOR 组）进行比较。术后肺部并发症（PPCs）定义为术后 30 天内发生的肺炎、肺不张、气胸、机械通气时间延长（>24 小时）和成人呼吸窘迫综合征。
LG 组和 OG 组的肺功能变量相似。LG 组的 PPCs 发生率略低于 OG 组（1.7%比 6.3%），但差异无统计学意义（p = 0.09）。LG 组与 NOR 组的 PPCs 发生率无差异（p>0.99）。对于 COPD 患者，晚期（2 或 3 期比 1 期）与 PPCs 显著相关（p = 0.03），但不是 PPCs 的独立危险因素（p = 0.12）。
LG 手术在患有轻度或中度 COPD 的胃癌患者中是可以耐受的，与 OG 相似。
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