Significance of Preoperative Pulmonary Function on Short- and Long-Term Outcomes Following Gastrectomy for Gastric Cancer

Abstract

Background Preoperative pulmonary function assessment is useful for selecting surgical candidates and operative methods and assessing the risk of postoperative pulmonary complications. However, few studies have investigated the relationship between preoperative pulmonary function and short-and long-term outcomes in patients who underwent gastrectomy for gastric cancer. Methods Of the 1040 patients with gastric cancer (stages I-III) who had undergone R0 gastrectomy between 2009 and 2020, 750 who underwent preoperative spirometry were included. Restrictive ventilatory impairment was defined as a vital capacity of the predicted value (%VC) < 80%, while obstructive ventilatory impairment was defined as forced expiratory volume in one second (FEV1%) < 70%. Postoperative complications were assessed using the Clavien-Dindo (CD) classification. The relationship between clinical factors, including %VC, FEV1%, severe postoperative complications (CD ≥ 3b), overall survival (OS), and relapse-free survival, were assessed. ResultsThe mean age of the 750 patients was 68 ± 10.5 years. Severe postoperative complications were observed in 25 (3.3%) patients and were significantly associated with FEV1% < 70% in the univariate analysis. The 5-year OS was 72.5%. Multivariate analysis showed that the cancer stage, age > 75 years, preoperative comorbidities, %VC < 80%, total gastrectomy, severe postoperative complications, and postoperative adjuvant chemotherapy were the significant independent factors affecting OS. Pneumonia was significantly associated with %VC < 80%. Conclusions FEV1% < 70%was associated with the development of severe postoperative complications, while %VC < 80% was associated with poor OS independent of the cancer stage because of death from pneumonia. Spirometry helps surgeons and patients discuss the risks and benefits of surgery.

Predictors of 1‐year mortality after gastrectomy for gastric cancer

“…Moreover, they are frequently associated with multiple comorbidities and high complication rates after gastrectomy. 4,33 Physiological dysfunction, multiple comorbidities, and postoperative complications may lead to decreased 1year survival rates.…”

“…Although some studies have shown that radical gastrectomy is feasible in selected elderly patients with GC, 3,31,32 these patients are vulnerable to and affected by various physiological dysfunctions. Moreover, they are frequently associated with multiple comorbidities and high complication rates after gastrectomy 4,33 . Physiological dysfunction, multiple comorbidities, and postoperative complications may lead to decreased 1‐year survival rates.…”

“…Gastric cancer (GC) is the fifth most common cancer and the third leading cause of cancer‐related deaths worldwide 1 . Gastrectomy is the most common treatment for GC and is widely performed in older patients with multiple comorbidities or advanced stages of the disease; however, there are major concerns regarding its efficacy for long‐term survival 2–4 . Surgeons are privileged to offer treatments that cure diseases.…”

“…1 Gastrectomy is the most common treatment for GC and is widely performed in older patients with multiple comorbidities or advanced stages of the disease; however, there are major concerns regarding its efficacy for long-term survival. [2][3][4] Surgeons are privileged to offer treatments that cure diseases. However, it is important to optimize comfort for those who cannot be cured or have a low life expectancy.Advanced care planning (ACP) supports patients in understanding and sharing their personal values, life goals, and preferences for future medical care.…”