Long-term postoperative pneumonia in elderly patients with early gastric cancer

Abstract

Background Pneumonia is a major cause of death in the elderly population. Considering body weight loss, muscle loss, and reflux after gastrectomy, elderly patients are considered to be at very high risk for pneumonia, which could decrease overall survival because early gastric cancer is mostly curable only by surgery. We aimed to clarify the incidence of pneumonia in the long-term period after gastrectomy in elderly patients who were diagnosed with early gastric cancer and its risk factors. Methods We retrospectively examined patients of > 75 years of age who underwent R0 gastrectomy for gastric cancer and who were diagnosed with T1 disease at National Cancer Center Hospital between 2005 and 2012. Long-term postoperative pneumonia was diagnosed by chest computed tomography every year until 2 years after surgery. The presence of preoperative sarcopenia was assessed using preoperative L3 skeletal muscle index. Results 167 patients were included in this study. Long-term postoperative pneumonia was observed in 44 (26%) patients. Of the 44 people diagnosed with long-term postoperative pneumonia, 33 were diagnosed in the 1st year and 11 in the 2nd year. 117 patients (70%) were diagnosed with sarcopenia which was significantly frequently found in the patients who developed long-term postoperative pneumonia (91%) than those without (63%). Preoperative sarcopenia was the only independent risk factor in multivariate analysis. Type of gastrectomy was not a significant risk factor. Conclusions Long-term postoperative pneumonia was frequently observed in the elderly patients. Preoperative sarcopenia was associated with long-term postoperative pneumonia in elderly patients who underwent curative surgery for gastric cancer. After gastrectomy, long-term special care would be required for elderly patients, especially with sarcopenia.

Comparison of medical resource consumption between oral cavity squamous cell carcinoma with and without sarcopenia: A nationwide population‐based cohort study

“…The effect of sarcopenia on the treatment costs of specific cancer types and OCSCC remains unclear. Compared with patients with cancer without sarcopenia, those with sarcopenia had more complications and a higher mortality rate 7–14 . However, no study has investigated the effect of sarcopenia on the health care costs of patients with OCSCC receiving curative surgery.…”

“…The prevalence of sarcopenia is associated with higher mortality and more postoperative complications in patients with cancer 7–14 . Sarcopenia is believed to impose a financial burden by resulting in disability, complications, mortality, and increased health care expenditure in patients with OCSCC.…”

“…In addition, inflammation caused by sarcopenia can reduce skeletal muscle density. Decreased muscle density is associated with intramuscular lipid accumulation and systemic inflammation, thus leading to a vicious cycle contributing to several treatment‐related complications 6–14,29 . Therefore, early intervention to break this cycle is critical for patients with sarcopenia 32–35 .…”

“…Therefore, the identification of risk factors for OCSCC is necessary. Many studies have reported that patients with cancer and sarcopenia undergoing curative surgery had poor oncological outcomes and high complication and mortality rates 7–14 . Moreover, not only patients with OCSCC and sarcopenia 6 but also those with lung cancer, esophageal cancer, or gastrointestinal cancer having sarcopenia exhibited poorer outcomes compared with patients with cancer but without sarcopenia 15–18 .…”

“…Many studies have reported that patients with cancer and sarcopenia undergoing curative surgery had poor oncological outcomes and high complication and mortality rates. [7][8][9][10][11][12][13][14] Moreover, not only patients with OCSCC and sarcopenia 6 but also those with lung cancer, esophageal cancer, or gastrointestinal cancer having sarcopenia exhibited poorer outcomes compared with patients with cancer but without sarcopenia. [15][16][17][18] Thus, sarcopenia has been attracting increasing attention by physicians in the field of head and neck cancer.…”