Department of Surgery, Tokyo Metropolitan Cancer and Infectious Diseases Center Komagome Hospital, Tokyo, Japan.
Department of Surgery, Yokohama City University, Yokohama, Japan.
Jpn J Clin Oncol. 2021 Jul 1;51(7):1044-1050. doi: 10.1093/jjco/hyab032.
Post-operative pneumonia is a major complication after general elective surgery in elderly patients and is often caused by aspiration associated with oesophageal reflux. The aim of this study was to identify the risk factors of post-operative pneumonia after gastrectomy in elderly patients with gastric cancer with two potential risk factors of ageing and oesophageal reflux.
We retrospectively examined the data of 251 patients ≥75 years old who underwent gastrectomy between January 2014 and December 2018 in our institution. The reconstruction methods were Billroth-I or Roux-Y after distal gastrectomy, jejunal interposition or double tract after proximal gastrectomy and Roux-Y after total gastrectomy. The severity of pneumonia was evaluated by the Clavien-Dindo classification.
Post-operative pneumonia was identified in 15 patients (5.9%) and was significantly associated with an age ≥80 years old, poor performance status, history of smoking and cardia-non-preserving gastrectomy (total gastrectomy and proximal gastrectomy) in univariate analyses. Multivariate analyses showed that a poor performance status and cardia-non-preserving gastrectomy were independent risk factors for post-operative pneumonia. The patients who suffered post-operative pneumonia required a longer hospital stay than those without post-operative pneumonia (P = 0.002).
We identified a poor performance status and cardia-non-preserving gastrectomy, which are likely to lead to oesophageal reflux, as risk factors for post-operative pneumonia in elderly patients with gastric cancer. These results warrant further prospective studies to evaluate their utility for reducing the rate of post-operative pneumonia in elderly patients through cardia-preserving gastrectomy or anti-reflux reconstruction.
术后肺炎是老年患者接受普通择期手术后的主要并发症，通常由与食管反流相关的误吸引起。本研究旨在确定两个潜在风险因素——年龄和食管反流——与胃癌相关的老年患者胃切除术后肺炎的危险因素。
我们回顾性分析了 2014 年 1 月至 2018 年 12 月在我院接受胃切除术的 251 名年龄≥75 岁的患者数据。重建方法为远端胃切除术后的 Billroth-I 或 Roux-Y、近端胃切除术后的空肠间置或双道以及全胃切除术后的 Roux-Y。肺炎严重程度采用 Clavien-Dindo 分级进行评估。
15 名患者（5.9%）出现术后肺炎，单因素分析显示，年龄≥80 岁、一般状况差、吸烟史和贲门非保留性胃切除术（全胃切除术和近端胃切除术）与术后肺炎显著相关。多因素分析显示，一般状况差和贲门非保留性胃切除术是术后肺炎的独立危险因素。发生术后肺炎的患者比未发生术后肺炎的患者需要更长的住院时间（P=0.002）。
我们确定了一般状况差和贲门非保留性胃切除术，这可能导致食管反流，是老年胃癌患者术后肺炎的危险因素。这些结果需要进一步的前瞻性研究，以通过贲门保留性胃切除术或抗反流重建来评估其在降低老年患者术后肺炎发生率方面的效用。
