Department of Gastroenterological Surgery, Cancer Institute Hospital, Japanese Foundation for Cancer Research, 3-8-31 Ariake, Koto-ku, Tokyo, 135-8550, Japan.
Gastric Cancer. 2014;17(3):548-55. doi: 10.1007/s10120-013-0292-4. Epub 2013 Aug 31.
The safety of surgery for gastric cancer in the elderly has been shown previously. However, potentially fatal complications based on an established severity grading system were not well described, and associated risk factors have not been assessed. The present study sought to examine severity-dependent postoperative complications after laparoscopy-assisted distal gastrectomy (LADG) in elderly patients and risk factors of potentially fatal postoperative complications.
The study included 189 patients aged 70 years or older and who underwent LADG for early gastric cancer. Patient characteristics, perioperative outcomes, postoperative complications including severity assessment using the Clavien-Dindo classification, and risk factors related to postoperative complications were analyzed.
The overall complication rate was 24.9 % (47/189). The most frequent complication was abdominal fluid collection (9 cases, 4.8 %). Severe complications classified as grade III or above in the Clavien-Dindo grading system were found in 20 (10.6 %) patients. Multivariate analysis identified preoperative serum albumin concentration (odds ratio, 5.200; 95 % CI, 1.706-15.850), Roux-en-Y reconstruction (odds ratio, 3.611; 95 % CI, 1.103-11.817), and simultaneous cholecystectomy (odds ratio, 5.008; 95 % CI, 1.378-18.201) as independent predictors of a higher rate of severe postoperative complications after LADG in elderly patients.
The incidence of severe complications after LADG in the elderly was quite acceptable considering the risks associated with radical surgery with extensive lymphadenectomy. Preoperative serum concentrations of albumin (<4.0 g/dl), Roux-en-Y reconstruction, and simultaneous cholecystectomy are independent risk factors for severe postoperative complications in these patients.
先前已经证明了老年人进行胃癌手术的安全性。然而，基于既定严重程度分级系统的潜在致命并发症并未得到很好的描述，并且尚未评估相关的危险因素。本研究旨在检查腹腔镜辅助远端胃切除术（LADG）后老年患者的严重程度依赖性术后并发症以及潜在致命术后并发症的危险因素。
本研究纳入了 189 名年龄在 70 岁或以上且接受 LADG 治疗早期胃癌的患者。分析了患者特征、围手术期结果、术后并发症（包括使用 Clavien-Dindo 分级进行严重程度评估）以及与术后并发症相关的危险因素。
总体并发症发生率为 24.9%（47/189）。最常见的并发症是腹腔积液（9 例，4.8%）。Clavien-Dindo 分级系统中分类为 III 级或更高级别的严重并发症在 20 名（10.6%）患者中发现。多变量分析确定术前血清白蛋白浓度（比值比，5.200；95%置信区间，1.706-15.850）、Roux-en-Y 重建（比值比，3.611；95%置信区间，1.103-11.817）和同时行胆囊切除术（比值比，5.008；95%置信区间，1.378-18.201）是老年患者 LADG 后严重术后并发症发生率较高的独立预测因素。
考虑到广泛淋巴结清扫根治手术相关的风险，老年患者 LADG 后严重并发症的发生率相当可以接受。术前血清白蛋白浓度（<4.0g/dl）、Roux-en-Y 重建和同时行胆囊切除术是这些患者严重术后并发症的独立危险因素。
