Prognostic Impact of Long-term Postoperative Pneumonia in Elderly Patients with Early Gastric Cancer

Abstract

Background: Elderly patients with stage I gastric cancer, a disease that is curable by surgery, easily develop long-term postoperative pneumonia (LTPP) within two years after surgery despite showing no active symptoms. The present study assessed whether or not LTPP determines the later prognosis among elderly patients. Methods: We retrospectively examined patients >75 years old who underwent R0 gastrectomy for gastric cancer and were diagnosed with T1 disease at National Cancer Center Hospital between 2005 and 2012. LTPP was evaluated by chest computed tomography every year until two years after surgery. Results: Of the 3412 patients who underwent gastrectomy in our hospital during this period, 159 were included in this study. The elderly patients who developed LTPP had a worse prognosis than those who did not. Furthermore, their comorbidities and LTPP were significant independent risk factors for a poor prognosis. Patients who developed LTPP had a significantly higher risk of dying due to respiratory disease or cardiovascular disease than those without pneumonia. Conclusions: LTPP was significantly related to a poor survival and death from respiratory disease. To improve the prognosis, not only nutritional support but also exercise and rehabilitation program may be required for patients who develop LTPP within two years after surgery.

Acceleration of sarcopenia in elderly patients who develop asymptomatic pneumonia shadow within one year after surgery for early gastric cancer

“…In this study, we could confirm that patients who developed APS had the poor prognosis as compared with those who did not as described in the previous study [ 14 ]. However, the patients who have accelerated sarcopenia had not so poor prognosis as compared with those who had not.…”

“…In the elderly population, pneumonia is one of the most frequent causes of death [ 12 ]. We previously investigated asymptomatic pneumonia shadow (APS) on chest computed tomography (CT) at regular follow-up in elderly patients who received surgical treatment for early gastric cancer [ 13 , 14 ]. Surprisingly, this pneumonia shadow was detected in approximately one-quarter of the elderly patients [ 13 ] and APS was significantly associated with poor survival [ 14 ].…”

“…We previously investigated asymptomatic pneumonia shadow (APS) on chest computed tomography (CT) at regular follow-up in elderly patients who received surgical treatment for early gastric cancer [ 13 , 14 ]. Surprisingly, this pneumonia shadow was detected in approximately one-quarter of the elderly patients [ 13 ] and APS was significantly associated with poor survival [ 14 ]. However, it remains unclear why APS worsens the prognosis despite being a silent shadow without active symptoms.…”