Department of Gastrointestinal Surgery, The Second Affiliated Hospital of Wenzhou Medical University and Yuying children's Hospital, Wenzhou, China.
Department of Gastrointestinal Surgery, The First Affiliated Hospital, Wenzhou Medical University, Wenzhou, China.
Cancer Med. 2020 Oct;9(19):7116-7124. doi: 10.1002/cam4.3352. Epub 2020 Aug 17.
Metabolic syndrome (MetS), a public health problem, is reportedly related to an increased risk of postoperative complications after surgery. However, whether MetS have an effect on complications after gastric cancer (GC) surgery are unknown. This study aimed to investigate the effects of preoperative MetS on complications after gastrectomy.
Altogether, 718 gastric cancer patients who planned to receive radical gastrectomy between June 2014 and December 2016 were enrolled, demographic and clinicopathological characteristics were analyzed. Univariate and multivariate analyses were performed to identify potential risk factors for postoperative complications. A predictive model for postoperative complications was constructed in the form of a nomogram, and its clinical usefulness was assessed.
Of the 628 patients ultimately included in the study (mean age 62.92 years, 450 men and 178 women), 84 were diagnosed with MetS preoperatively. Severe postoperative complications (Clavien-Dindo grade ≥II) were significantly more common in patients with MetS (41.7% versus 23.7%, P < .001). Predictors of postoperative complications included MetS (odds ratio [OR] = 1.800, P = .023), age (OR = 1.418, P = .050), Charlson score (OR = 1.787, P = .004 for 1-2 points) and anastomosis type (OR = 1.746, P = .007 for Billroth II reconstruction). The high-risk rating had a high AUC (ROC I = 0.503, ROC Ib = 0.544, ROC IIa = 0.601, ROC IIb = 0.612, ROC IIc = 0.638, ROC III = 0.735), indicating that the risk-rating model has good discriminative capacity and clinical usefulness.
MetS was an independent risk factor for complications after gastrectomy. The nomogram and rating model incorporating MetS, Billroth II anastomosis, age, and Charlson score was useful for individualized prediction of postoperative complications.
代谢综合征（MetS）是一种公共卫生问题，据报道与手术后并发症的风险增加有关。然而，代谢综合征是否会对胃癌（GC）手术后的并发症产生影响尚不清楚。本研究旨在探讨术前代谢综合征对胃癌手术后并发症的影响。
共纳入 2014 年 6 月至 2016 年 12 月期间计划接受根治性胃切除术的 718 例胃癌患者，分析其人口统计学和临床病理特征。进行单因素和多因素分析，以确定术后并发症的潜在危险因素。以列线图的形式构建术后并发症预测模型，并评估其临床实用性。
最终纳入研究的 628 例患者（平均年龄 62.92 岁，男性 450 例，女性 178 例）中，术前诊断为代谢综合征的有 84 例。患有严重术后并发症（Clavien-Dindo 分级≥II 级）的患者中，代谢综合征患者明显更多（41.7% vs. 23.7%，P<0.001）。术后并发症的预测因素包括代谢综合征（比值比[OR] = 1.800，P = 0.023）、年龄（OR = 1.418，P = 0.050）、Charlson 评分（1-2 分的 OR = 1.787，P = 0.004）和吻合方式（OR = 1.746，P = 0.007，Billroth II 重建）。高危评分具有较高的 AUC（ROC I = 0.503，ROC Ib = 0.544，ROC IIa = 0.601，ROC IIb = 0.612，ROC IIc = 0.638，ROC III = 0.735），表明风险评分模型具有良好的判别能力和临床实用性。
代谢综合征是胃癌手术后并发症的独立危险因素。纳入代谢综合征、Billroth II 吻合术、年龄和 Charlson 评分的列线图和评分模型可用于术后并发症的个体化预测。
