Suzuki Satoshi, Kanaji Shingo, Matsuda Yoshiko, Yamamoto Masashi, Hasegawa Hiroshi, Yamashita Kimihiro, Oshikiri Taro, Matsuda Takeru, Sumi Yasuo, Nakamura Tetsu, Kakeji Yoshihiro
Division of Gastrointestinal Surgery Department of Surgery Graduate School of Medicine Kobe University Kobe Hyogo Japan.
Ann Gastroenterol Surg. 2017 Sep 19;2(1):72-78. doi: 10.1002/ags3.12037. eCollection 2018 Jan.
With the extension of life expectancy, cancer has been increasing in elderly populations. Postoperative pneumonia can negatively influence immediate mortality following gastrectomy for elderly patients, but its impact on long-term survival remains unclear. We retrospectively reviewed the cases of patients aged ≥75 years who underwent curative gastrectomy for gastric cancer from 2000 to 2014 to determine the long-term effects of postoperative pneumonia and to identify independent risk factors along with physical status and surgical procedure. Of 250 patients, 32 (12.8%) developed postoperative pneumonia. Patients with postoperative pneumonia had significantly worse overall survival (OS) than those without postoperative pneumonia (.001). A multivariate analysis identified postoperative pneumonia as a prognostic factor for OS (hazard ratio, 2.06; 95% CI, 1.05-3.75; =.036). Significant risk factors for the development of postoperative pneumonia were male gender (=.026) and D2 lymphadenectomy (<.001). D2 lymphadenectomy was associated with poorer OS than D1 or D1+lymphadenectomy in patients with an American Society of Anesthesiologists (ASA) score 3 (=.026), but did not influence OS negatively in patients with an ASA score ≤2. Limited lymphadenectomy did not affect the cancer-specific survival of elderly patients with ASA score 3. Postoperative pneumonia following gastrectomy has an adverse impact on the long-term survival of elderly gastric cancer patients. A limited lymphadenectomy during curative resection should be considered to prevent postoperative pneumonia in frail elderly patients with ASA score 3. Postoperative pneumonia following gastrectomy has an adverse impact on the long-term survival of elderly gastric cancer patients. Extent of lymph node dissection during curative resection should be limited to prevent postoperative pneumonia, based on the patient's frailty.
随着预期寿命的延长，老年人群中的癌症发病率一直在上升。术后肺炎会对老年患者胃癌切除术后的近期死亡率产生负面影响，但其对长期生存的影响尚不清楚。我们回顾性分析了2000年至2014年期间接受胃癌根治性胃切除术的≥75岁患者的病例，以确定术后肺炎的长期影响，并确定与身体状况和手术方式相关的独立危险因素。在250例患者中，32例（12.8%）发生了术后肺炎。发生术后肺炎的患者的总生存期（OS）明显低于未发生术后肺炎的患者（P = 0.001）。多因素分析确定术后肺炎是OS的一个预后因素（风险比，2.06；95%可信区间，1.05 - 3.75；P = 0.036）。术后肺炎发生的显著危险因素是男性（P = 0.026）和D2淋巴结清扫术（P < 0.001）。对于美国麻醉医师协会（ASA）评分为3分的患者，D2淋巴结清扫术与D1或D1 + 淋巴结清扫术相比，OS较差（P = 0.026），但对ASA评分≤2分的患者的OS没有负面影响。有限的淋巴结清扫术不影响ASA评分为3分的老年患者的癌症特异性生存期。胃癌切除术后的术后肺炎对老年胃癌患者的长期生存有不利影响。对于ASA评分为3分的体弱老年患者，应考虑在根治性切除术中进行有限的淋巴结清扫以预防术后肺炎。胃癌切除术后的术后肺炎对老年胃癌患者的长期生存有不利影响。基于患者的身体虚弱程度，根治性切除术中淋巴结清扫的范围应加以限制以预防术后肺炎。
