Klingbeil Kyle D, Mederos Michael, Park Joon Y, Seo Young-Ji, Markovic Daniela, Chui Victor, Girgis Mark, Kadera Brian E
Department of Surgery, Division of Surgical Oncology, UCLA David Geffen School of Medicine, Los Angeles, CA, USA.
Department of Medicine, Statistics Core, UCLA David Geffen School of Medicine, Los Angeles, CA, USA.
Surg Open Sci. 2023 Jul 20;14:68-74. doi: 10.1016/j.sopen.2023.07.006. eCollection 2023 Aug.
Whether laparoscopic approach to gastrectomy for gastric cancer (GC) reduces the risk of pneumonia remains unknown. In this study, we compared pneumonia outcomes for patients with GC who underwent either laparoscopic gastrectomy (LG) or open gastrectomy (OG).
The ACS NSQIP database was queried to identify patients with GC who underwent LG or OG between Jan 2012 - Dec 2018. Outcomes were compared using regression models. A post-hoc analysis was performed for elderly patients.
The study cohort included 2661 patients, 23.4 % undergoing LG. Laparoscopic approach lowered pneumonia risk (OR 0.47, = .028) and reduced hospital length of stay, (5.3 vs 7.1 days, < .001). Elderly patients undergoing LG demonstrated similar benefits. Risk factors for pneumonia included advanced age, dyspnea and weight-loss, whereas laparoscopic approach reduced this risk.
LG in patients with GC has both statistically and clinically significant advantages over OG with respect to pneumonia. Further studies are needed to validate the relationship between postoperative pneumonia and surgical approach for gastrectomy.
腹腔镜胃癌切除术是否能降低肺炎风险尚不清楚。在本研究中，我们比较了接受腹腔镜胃切除术（LG）或开腹胃切除术（OG）的胃癌患者的肺炎发生情况。
查询美国外科医师学会国家外科质量改进计划（ACS NSQIP）数据库，以识别2012年1月至2018年12月期间接受LG或OG的胃癌患者。使用回归模型比较结果。对老年患者进行了事后分析。
研究队列包括2661例患者，其中23.4%接受LG。腹腔镜手术降低了肺炎风险（比值比[OR]为0.47，P = 0.028），并缩短了住院时间（5.3天对7.1天，P < 0.001）。接受LG的老年患者也有类似的获益。肺炎的危险因素包括高龄、呼吸困难和体重减轻，而腹腔镜手术降低了这种风险。
在肺炎方面，LG相对于OG在统计学和临床上均具有显著优势。需要进一步研究来验证术后肺炎与胃切除术手术方式之间的关系。
