Aoyama Toru, Maezawa Yukio, Yoshikawa Takaki, Segami Kenki, Kano Kazuki, Hayashi Tsutomu, Yamada Takanobu, Numata Masakatsu, Goda Motohico, Tamagawa Hiroshi, Sato Tsutomu, Yukawa Norio, Rino Yasushi, Masuda Munetaka, Ogata Takashi, Cho Haruhiko, Oshima Takashi
Department of Gastrointestinal Surgery, Kanagawa Cancer Center, Yokohama, Japan
Department of Surgery, Yokohama City University, Yokohama, Japan.
In Vivo. 2019 Jan-Feb;33(1):221-227. doi: 10.21873/invivo.11463.
Body weight, especially lean body mass, significantly decreases after gastrectomy for gastric cancer due to surgical invasion, reduced food intake, and reduced mobility, which can reduce the quality of life and induce associated toxicity or reduce compliance with adjuvant chemotherapy. Such risks can be particularly high in elderly patients with gastric cancer. However, whether or not changes in the weight and body composition differ between elderly and non-elderly patients remains unclear.
This retrospective study examined patients who underwent curative surgery for gastric cancer between May 2010 and February 2017. Body weight and composition were evaluated by a bioelectrical impedance analyzer within 1 week before surgery, at 1 week after surgery, and at 1 and at 3 months after surgery. Patients were classified as elderly (≥80 years) or non-elderly (<80 years).
Eight-hundred and eighty-eight patients (84 elderly and 804 non-elderly) were entered into the present study. Patient background, surgical and clinicopathological factors, and surgical complications did not significantly differ between the two groups. Body weight loss at 1 week, and at 1 and 3 months after surgery, defined as the decrease from the preoperative value, were -2.8%, -6.5%, and -9.0%, respectively, in the elderly and -3.5%, -6.0%, and -8.1%, respectively, in the non-elderly patients (p=0.111, 0.125, and 0.153, respectively). The corresponding losses of lean body mass were -2.6%, -6.0%, and -6.4%, respectively, in the elderly and -3.5%, -4.9%, and -4.7%, respectively, in the non-elderly patients, with p-values of 0.056, 0.036, and 0.029, respectively.
Decreases in lean body mass after gastrectomy were greater in elderly than in non-elderly patients. In order to maintain lean body mass among elderly patients, additional care and treatments are needed.
由于手术侵袭、食物摄入量减少和活动能力下降,胃癌胃切除术后体重,尤其是瘦体重会显著降低,这会降低生活质量,并引发相关毒性反应或降低辅助化疗的依从性。此类风险在老年胃癌患者中可能尤其高。然而,老年患者与非老年患者的体重和身体成分变化是否存在差异仍不明确。
这项回顾性研究对2010年5月至2017年2月期间接受胃癌根治性手术的患者进行了检查。在手术前1周、手术后1周以及手术后1个月和3个月,使用生物电阻抗分析仪评估体重和身体成分。患者分为老年组(≥80岁)和非老年组(<80岁)。
本研究纳入了888例患者(84例老年患者和804例非老年患者)。两组患者的背景、手术及临床病理因素以及手术并发症无显著差异。老年患者术后1周、1个月和3个月的体重减轻(定义为较术前值的下降幅度)分别为-2.8%、-6.5%和-9.0%,非老年患者分别为-3.5%、-6.0%和-8.1%(p值分别为0.111、0.125和0.153)。老年患者相应的瘦体重损失分别为-2.6%、-6.0%和-6.4%,非老年患者分别为-3.5%、-4.9%和-4.7%,p值分别为0.056、0.036和0.029。
胃切除术后老年患者的瘦体重下降幅度大于非老年患者。为了维持老年患者的瘦体重,需要额外的护理和治疗。