Jeong Oh, Ryu Seong Yeop, Park Young Kyu
Division of Gastroenterologic Surgery, Department of Surgery, Chonnam National University Hwasun Hospital, Hwasun, Korea.
J Korean Surg Soc. 2013 Jan;84(1):18-26. doi: 10.4174/jkss.2013.84.1.18. Epub 2012 Dec 26.
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.
我们评估了术前肺功能测定对术后发病率的预测价值，以及与胃癌手术后肺功能异常相关的并发症的性质。
在2009年2月至2010年3月期间，538例行腹腔镜手术（n = 247）和开腹胃切除术（n = 291）的胃癌患者，根据术前肺功能测定结果，分为肺功能正常组（一秒用力呼气容积[FEV(1)]/用力肺活量[FVC]≥0.7，n = 441）和肺功能异常组（FEV(1)/FVC < 0.7，n = 97）。采用单因素和多因素分析评估肺功能测定对术后发病率的预测价值。
术后，肺功能异常组局部并发症（29.9%对18.1%，P = 0.009）和全身并发症（8.2%对2.0%，P = 0.005）的发生率显著高于正常组。在局部并发症中，吻合口漏和伤口并发症在肺功能异常组更为常见。在单因素和多因素分析中，调整年龄、全胃切除术、开放手术和肿瘤-淋巴结-转移分期后，肺功能异常是术后局部并发症的独立预测因素（比值比，1.75；95%置信区间，1.03至2.97）。同时，年龄大和肺部疾病史是全身并发症的独立预测因素。
术前肺功能测定是预测胃癌手术后术后发病率的一种简单而有用的方法。鉴于其简单性和低成本，我们建议增加术前肺功能测定以评估手术风险，并有助于制定适当的围手术期治疗计划。
