Department of Gastrointestinal Surgery, Japanese Red Cross Aichi Medical Center Nagoya Daiichi Hospital, 3-35 Michishita-Cho, Nakamura-Ku, Nagoya, 453-8511, Japan.
J Gastrointest Surg. 2023 May;27(5):866-877. doi: 10.1007/s11605-023-05582-3. Epub 2023 Jan 19.
Preoperative pulmonary function assessment is useful for selecting surgical candidates and operative methods and assessing the risk of postoperative pulmonary complications. However, few studies have investigated the relationship between preoperative pulmonary function and short- and long-term outcomes in patients who underwent gastrectomy for gastric cancer.
Of the 1040 patients with gastric cancer (stages I-III) who had undergone R0 gastrectomy between 2009 and 2020, 750 who underwent preoperative spirometry were included. Restrictive ventilatory impairment was defined as a vital capacity of the predicted value (%VC) < 80%, while obstructive ventilatory impairment was defined as forced expiratory volume in one second (FEV1%) < 70%. Postoperative complications were assessed using the Clavien-Dindo (CD) classification. The relationship between clinical factors, including %VC, FEV1%, severe postoperative complications (CD ≥ 3b), overall survival (OS), and relapse-free survival, were assessed.
The mean age of the 750 patients was 68 ± 10.5 years. Severe postoperative complications were observed in 25 (3.3%) patients and were significantly associated with FEV1% < 70% in the univariate analysis. The 5-year OS was 72.5%. Multivariate analysis showed that the cancer stage, age > 75 years, preoperative comorbidities, %VC < 80%, total gastrectomy, severe postoperative complications, and postoperative adjuvant chemotherapy were the significant independent factors affecting OS. Pneumonia was significantly associated with %VC < 80%.
FEV1% < 70%was associated with the development of severe postoperative complications, while %VC < 80% was associated with poor OS independent of the cancer stage because of death from pneumonia. Spirometry helps surgeons and patients discuss the risks and benefits of surgery.
术前肺功能评估有助于选择手术候选者和手术方法，并评估术后肺部并发症的风险。然而，很少有研究调查接受胃癌根治性胃切除术的患者术前肺功能与短期和长期结局之间的关系。
纳入了 2009 年至 2020 年间接受 R0 胃切除术的 1040 例胃癌（I-III 期）患者，其中 750 例行术前肺功能检查。限制性通气障碍定义为预计值肺活量（%VC）<80%，而阻塞性通气障碍定义为一秒用力呼气量（FEV1%）<70%。采用 Clavien-Dindo（CD）分类评估术后并发症。评估包括%VC、FEV1%、严重术后并发症（CD≥3b）、总生存期（OS）和无复发生存率在内的临床因素与临床因素之间的关系。
750 例患者的平均年龄为 68±10.5 岁。25 例（3.3%）患者出现严重术后并发症，单因素分析显示与 FEV1%<70%显著相关。5 年 OS 为 72.5%。多因素分析显示，癌症分期、年龄>75 岁、术前合并症、%VC<80%、全胃切除术、严重术后并发症和术后辅助化疗是影响 OS 的独立显著因素。肺炎与%VC<80%显著相关。
FEV1%<70%与严重术后并发症的发生有关，而%VC<80%与 OS 不良有关，这与因肺炎导致的死亡有关，而与癌症分期无关。肺功能检查有助于外科医生和患者讨论手术的风险和益处。
