Inokuchi Mikito, Kojima Kazuyuki, Kato Keiji, Sugita Hirofumi, Sugihara Kenichi
1 Department of Surgical Oncology, Tokyo Medical and Dental University , Tokyo, Japan .
Surg Infect (Larchmt). 2014 Jun;15(3):314-21. doi: 10.1089/sur.2013.031. Epub 2014 May 5.
Post-operative pulmonary complications (PPCs) negatively affect patients' quality of life and can be life-threatening. Predictors of PPCs have been evaluated in patients who underwent various operations, but few studies have specifically focused on gastrectomy.
We retrospectively studied 1,053 patients with gastric adenocarcinoma who underwent radical gastrectomy with lymphadenectomy in our hospital between 1999 and 2011. Post-operative pulmonary complications were defined as conditions such as pneumonia, macroscopic atelectasis, pneumothorax, and acute respiratory distress syndrome that developed within 30 d after surgery. We evaluated the relations between PPCs and pre-operative or intra-operative factors and assessed risk factors for PPCs after gastrectomy.
A total of 49 (4.7%) patients had PPCs. On univariate analysis, PPCs were significantly associated with male gender (p=0.024), predicted vital capacity (VC) (p=0.020), a lower pre-operative serum albumin concentration (p=0.023), open surgery (p=0.007), total gastrectomy (p<0.001), combined resection of another organ (p=0.001), extended operating time (p<0.001), higher operative bleeding volume (p<0.001), intra-operative or post-operative blood transfusion (p=0.009), and pathologic tumor stage (p=0.003). On multivariable analysis, extended operating time (odds ratio [OR], 3.21, 95% confidence interval [CI] 1.46-7.07; p=0.004), total gastrectomy (OR, 2.65, 95% CI 1.25-5.59; p=0.011) and predicted VC (OR, 2.42, 95% CI 1.01-5.85; p=0.049) were independent risk factors. These three factors also were independent risk factors for post-operative pneumonia (total gastrectomy OR, 2.64, 95% CI 1.32-5.30; p=0.006); extended operating time OR, 2.54, 95% CI 1.24-5.19; p=0.011; and predicted VC OR, 2.41, 95% CI 1.01-5.75; p=0.048).
Extended operating time, total gastrectomy, and predicted VC were independent predictors of PPCs, particularly pneumonia, in patients with gastric cancer who underwent gastrectomy. In patients with restrictive pulmonary dysfunction who are scheduled to undergo total gastrectomy, reduced lymphadenectomy or the avoidance of combined resection should be considered to shorten the operating time.
术后肺部并发症（PPCs）会对患者的生活质量产生负面影响，甚至可能危及生命。已有研究对接受各种手术患者的PPCs预测因素进行了评估，但专门针对胃切除术的研究较少。
我们回顾性研究了1999年至2011年间在我院接受根治性胃切除术及淋巴结清扫术的1053例胃腺癌患者。术后肺部并发症定义为术后30天内发生的肺炎、肉眼可见的肺不张、气胸和急性呼吸窘迫综合征等情况。我们评估了PPCs与术前或术中因素之间的关系，并评估了胃切除术后PPCs的危险因素。
共有49例（4.7%）患者发生PPCs。单因素分析显示，PPCs与男性性别（p = 0.024）、预计肺活量（VC）（p = 0.020）、术前血清白蛋白浓度较低（p = 0.023）、开放手术（p = 0.007）、全胃切除术（p < 0.001）、联合切除其他器官（p = 0.001）、手术时间延长（p < 0.001）、术中出血量较多（p < 0.001）、术中或术后输血（p = 0.009）以及病理肿瘤分期（p = 0.003）显著相关。多因素分析显示，手术时间延长（比值比[OR]，3.21，95%置信区间[CI] 1.46 - 7.07；p = 0.004）、全胃切除术（OR，2.65，95% CI 1.25 - 5.59；p = 0.011）和预计VC（OR，2.42，95% CI 1.01 - 5.85；p = 0.049）是独立危险因素。这三个因素也是术后肺炎的独立危险因素（全胃切除术OR，2.64，95% CI 1.32 - 5.30；p = 0.006）；手术时间延长OR，2.54，95% CI 1.24 - 5.19；p = 0.011；预计VC OR，2.41，95% CI 1.01 - 5.75；p = 0.048）。
手术时间延长、全胃切除术和预计VC是接受胃切除术的胃癌患者发生PPCs尤其是肺炎的独立预测因素。对于计划接受全胃切除术且存在限制性肺功能障碍的患者，应考虑减少淋巴结清扫或避免联合切除以缩短手术时间。
