Postoperative complications in the oldest old gastric cancer patients

Yamada, Hiroyuki; Shinohara, Takaaki; Takeshita, Masashi; Umesaki, Tetsuya; Fujimori, Yoshiro; Yamagishi, Kazumasa

doi:10.1016/j.ijsu.2013.04.005

Cited by 40 publications

(32 citation statements)

References 31 publications

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“…Kunisaki et al reported that the frequency of pneumonia differed significantly between patients aged 45-65 and those aged ≥75 years (6.3 vs. 13.3 %, respectively) [6]. Moreover, Yamada et al reported that the frequency of pneumonia was significantly higher in patients aged ≥85 years than in those aged 75-84 years (16.7 vs. 3.3 %, respectively) [8]. The results of these two studies show that the risk of pneumonia increases with age, consistent with our findings, although these previous studies did not focus solely on postoperative pneumonia and did not perform multivariate analysis to identify risk factors for postoperative pneumonia.…”

Section: Discussionmentioning

confidence: 99%

“…Another limitation is the cutoff for the definition of "elderly" patients. Various cutoffs have been used for defining elderly patients [7]; however, as a cutoff of 75 years has been used recently in many reports [6,8], we used this cutoff in the present study.…”

Section: Discussionmentioning

confidence: 99%

“…The incidence of postoperative complications in elderly patients remains high, because these patients tend to have impaired physiological function of various organs as well as concurrent diseases [4,5]. In particular, aging-related anatomical and physiological changes partly impair swallowing in elderly people, which is considered to increase the risk of postoperative pneumonia [3,[5][6][7][8]. However, no study has sufficiently investigated which clinicopathological factors are significant risk factors for postoperative pneumonia after gastrectomy with lymph node dissection.…”

Section: Introductionmentioning

confidence: 99%

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Risk factors for postoperative pneumonia after gastrectomy for gastric cancer

et al. 2015

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Risk factors for postoperative pneumonia after gastrectomy for gastric cancer

et al. 2015

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“…Frequency of pneumonia after gastrectomy in elderly patients aged ≥75 years has been reported as 5.1‐13.3%, which is significantly higher than that of younger patients (ie 45‐65 years old) . Pneumonia developed in 12.8% of the present patients, which is similar to findings of previous studies, but advanced age (≥80 years) did not increase the incidence of pneumonia in our study cohort.…”

Section: Discussionmentioning

confidence: 99%

Long‐term impact of postoperative pneumonia after curative gastrectomy for elderly gastric cancer patients

Suzuki

Kanaji

Matsuda

et al. 2017

Annals of Gastroent Surgery

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With the extension of life expectancy, cancer has been increasing in elderly populations. Postoperative pneumonia can negatively influence immediate mortality following gastrectomy for elderly patients, but its impact on long‐term survival remains unclear. We retrospectively reviewed the cases of patients aged ≥75 years who underwent curative gastrectomy for gastric cancer from 2000 to 2014 to determine the long‐term effects of postoperative pneumonia and to identify independent risk factors along with physical status and surgical procedure. Of 250 patients, 32 (12.8%) developed postoperative pneumonia. Patients with postoperative pneumonia had significantly worse overall survival (OS) than those without postoperative pneumonia (P<.001). A multivariate analysis identified postoperative pneumonia as a prognostic factor for OS (hazard ratio, 2.06; 95% CI, 1.05‐3.75; P=.036). Significant risk factors for the development of postoperative pneumonia were male gender (P=.026) and D2 lymphadenectomy (P<.001). D2 lymphadenectomy was associated with poorer OS than D1 or D1+lymphadenectomy in patients with an American Society of Anesthesiologists (ASA) score 3 (P=.026), but did not influence OS negatively in patients with an ASA score ≤2. Limited lymphadenectomy did not affect the cancer‐specific survival of elderly patients with ASA score 3. Postoperative pneumonia following gastrectomy has an adverse impact on the long‐term survival of elderly gastric cancer patients. A limited lymphadenectomy during curative resection should be considered to prevent postoperative pneumonia in frail elderly patients with ASA score 3. Postoperative pneumonia following gastrectomy has an adverse impact on the long‐term survival of elderly gastric cancer patients. Extent of lymph node dissection during curative resection should be limited to prevent postoperative pneumonia, based on the patient's frailty.

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“…29 In a study by Yamada et al, wherein the elderly group was defined as being 85 years and above, ASA grade, CCI, forced expiratory volume at 1 second (FEV1) and serum albumin concentration correlated with the occurrence of postoperative pneumonia. 30 Tran et al reported that age (≥ 80 years defined as elderly), blood transfusion, serum albumin and creatinine were independent predictors of 90-day mortality rate and tumour stage. Tumour grade, race, blood transfusion and adjuvant therapy were independently associated with disease-specific survival.…”

Section: Discussionmentioning

confidence: 99%

Laparoscopy-assisted gastrectomy in the elderly: experience from a UK centre

Tandon

Rajendran

Aziz

et al. 2017

annals

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BACKGROUND Gastric cancer has a high incidence in the elderly in the UK, with a significant number of patients aged 75 years or more. While surgery forms the mainstay of treatment, evidence pertaining to the management of gastric cancer in the Western population in this age group is scarce. METHODS We retrospectively reviewed the outcomes of laparoscopy-assisted total and distal gastrectomies at our centre from 2005 to 2015. Patients aged 70 years or above were included in the elderly group. RESULTS A total of 60 patients underwent laparoscopy-assisted gastrectomy over a 10-year period, with a predominance of male patients. There was no significant difference in the rate of overall surgical and non-surgical complications, in-hospital mortality, operation time and length of hospital stay, between the elderly and non-elderly groups. Univariate analysis, performed for risk factors relating to anastomotic leak and surgical complications, showed that age over 70 years and higher American Association of Anesthesiologists grades are associated with a higher, though not statistically significant, number of anastomotic leaks (P = 1.000 and P = 0.442, respectively) and surgical complications (P = 0.469 and P = 0.162, respectively). The recurrence rate within the first 3 years of surgery was significantly higher in the non-elderly group compared with the elderly group (Log Rank test, P = 0.002). There was no significant difference in survival between the two groups (Log Rank test, P = 0.619). CONCLUSIONS Laparoscopy-assisted gastrectomy is safe and feasible in an elderly population. There is a need for well-designed, prospective, randomised studies with quality of life data to inform our practice in future.

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Postoperative complications in the oldest old gastric cancer patients

Abstract: Patients over 85 years old are more likely to suffer postoperative pneumonia after gastrectomy than younger old patients. Preoperative risk assessment is essential for the oldest old patients.

Cited by 40 publications

References 31 publications

Risk factors for postoperative pneumonia after gastrectomy for gastric cancer

Risk factors for postoperative pneumonia after gastrectomy for gastric cancer

Long‐term impact of postoperative pneumonia after curative gastrectomy for elderly gastric cancer patients

Laparoscopy-assisted gastrectomy in the elderly: experience from a UK centre

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