Department of Gastrointestinal Surgery, Saitama Medical University International Medical Center, 1397-1, Yamane, Hidaka-Shi, Saitama, 350-1298, Japan.
Division of Advanced Surgical Oncology, Research and Development Center for New Medical Frontiers, Kitasato University School of Medicine, 1-15-1 Kitasato, Minami-Ku, Kanagawa, Sagamihara-Shi, 252-0374, Japan.
Sci Rep. 2024 Aug 23;14(1):19605. doi: 10.1038/s41598-024-68806-9.
The influence of pulmonary dysfunction on postoperative outcomes in older patients with gastric cancer was assessed. In this retrospective study, 352 older patients (age ≥ 75 years) with gastric cancer who underwent preoperative spirometry and curative gastrectomy were enrolled. Of these patients, 200 underwent laparoscopic gastrectomy. Restrictive and obstructive pulmonary dysfunction were defined as percentage of vital capacity (%VC) < 80% and percent of forced expiratory volume in one second (FEV1.0%) < 70%, respectively. Twenty-six (7.3%) and 123 (34.9%) exhibited restrictive and obstructive pulmonary dysfunction, respectively. The low-%VC group showed a higher incidence of postoperative pneumonia (p = 0.018) while the low-FEV1.0% group did not (p = 0.677). Multivariate analysis identified a decreased %VC as a significant risk factor for postoperative pneumonia. However, this association was not observed in patients who underwent laparoscopic gastrectomy. Concerning the long-term outcomes, restrictive dysfunction was a significant prognostic factor in older patients with gastric cancer who underwent either laparotomy or laparoscopy, whereas obstructive dysfunction did not. Restrictive pulmonary dysfunction increased the risk of postoperative pneumonia and had a negative prognostic effect in older patients with gastric cancer, whereas obstructive pulmonary dysfunction did not.
评估了肺功能障碍对老年胃癌患者术后结局的影响。在这项回顾性研究中，纳入了 352 名接受术前肺功能检查和根治性胃切除术的老年胃癌患者（年龄≥75 岁）。其中 200 例行腹腔镜胃切除术。限制性和阻塞性肺功能障碍分别定义为肺活量（%VC）<80%和一秒用力呼气量（FEV1.0%）<70%。分别有 26（7.3%）和 123（34.9%）例患者出现限制性和阻塞性肺功能障碍。低-%VC 组术后肺炎发生率较高（p=0.018），而低-FEV1.0%组则无差异（p=0.677）。多变量分析确定 %VC 降低是术后肺炎的显著危险因素。然而，这种关联在接受腹腔镜胃切除术的患者中并未观察到。关于长期结局，在接受剖腹或腹腔镜手术的老年胃癌患者中，限制性功能障碍是一个显著的预后因素，而阻塞性功能障碍则不是。限制性肺功能障碍增加了老年胃癌患者术后肺炎的风险，并具有负面的预后影响，而阻塞性肺功能障碍则没有。
