Liu Xiao, Xue Zhigang, Yu Jianchun, Li Zijian, Ma Zhiqiang, Kang Weiming, Ye Xin, Jiang Lin
Department of Surgery, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing, People's Republic of China.
Department of General Surgery, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing, People's Republic of China.
Cancer Manag Res. 2020 Jun 9;12:4391-4398. doi: 10.2147/CMAR.S253649. eCollection 2020.
Elderly patients with gastric cancer (GC) are at increased risk of infectious complications following gastrectomy. A limited set of risk factors has been identified to predict complications in these patients. To improve the safety of gastrectomy in this population, we investigated the incidence of infectious complications and associated clinicopathologic, nutritional and surgical risk factors in a cohort of elderly patients with GC.
Elderly GC patients (≥70 years) who underwent gastrectomy between January 2013 and December 2017 in Peking Union Medical College Hospital were included in the study. Clinicopathologic data were collected retrospectively. Severity of complications was classified using the Clavien-Dindo system. Infectious complications were assessed based on clinical diagnosis of health care-associated infection as defined by the US Centers for Disease Control and Prevention. Multivariate logistic regression analyses were performed to determine the risk factors for infectious complications.
Three hundred thirty-one consecutive patients were included, with a median age of 74 years (range 70-88). The rate of surgical morbidity was 37.5% and the mortality rate was 1.2%. The incidence of infectious complications was 19.6%, with the most common infectious complication being pulmonary infection (11.5%). Preoperative weight loss ≥5% (odds ratio [OR] = 2.21; 95% CI, 1.15-4.28; p = 0.018), Charlson comorbidity index score ≥3 (OR = 2.83; 95% CI, 1.30-6.16; p = 0.009) and preoperative hsCRP level ≥10 mg/L (OR = 2.48; 95% CI, 1.14-5.38; p = 0.022) were independently associated with infectious complications.
Preoperative weight loss, elevated hsCRP level and comorbidity burden can be used to predict postoperative infectious complications in elderly GC patients. It is recommended to pay more attention to the treatment of elderly GC patients with these risk factors.
老年胃癌（GC）患者在胃切除术后发生感染性并发症的风险增加。已确定了一组有限的危险因素来预测这些患者的并发症。为提高该人群胃切除术的安全性，我们调查了一组老年GC患者中感染性并发症的发生率以及相关的临床病理、营养和手术危险因素。
纳入2013年1月至2017年12月在北京协和医院接受胃切除术的老年GC患者（≥70岁）。回顾性收集临床病理数据。使用Clavien-Dindo系统对并发症的严重程度进行分类。根据美国疾病控制与预防中心定义的医疗保健相关感染的临床诊断评估感染性并发症。进行多因素逻辑回归分析以确定感染性并发症的危险因素。
连续纳入331例患者，中位年龄74岁（范围70 - 88岁）。手术发病率为37.5%，死亡率为1.2%。感染性并发症的发生率为19.6%，最常见的感染性并发症是肺部感染（11.5%）。术前体重减轻≥5%（比值比[OR]=2.21；95%可信区间[CI]，1.15 - 4.28；p = 0.018）、Charlson合并症指数评分≥3（OR = 2.83；95% CI，1.30 - 6.16；p = 0.009）和术前超敏C反应蛋白（hsCRP）水平≥10 mg/L（OR = 2.48；95% CI，1.14 - 5.38；p = 0.022）与感染性并发症独立相关。
术前体重减轻、hsCRP水平升高和合并症负担可用于预测老年GC患者术后感染性并发症。建议对具有这些危险因素的老年GC患者给予更多关注。
