An evaluation of risk factors for overall complications after curative gastrectomy in gastric cancer patients aged 65 or over
Öz
Aim:
The purpose of this study was to identify risk factors for postoperative complications in patients with gastric cancer aged 65 or over.
Methods:
Data from medical records in our database were reviewed and analyzed retrospectively. Two hundred twenty-nine patients with histologically confirmed gastric cancer underwent curative gastrectomy in our clinic between January 2017 and December 2021. Eighty-eight patients younger than 65 and 21 with previous histories of abdominal surgery, multi-visceral resection, emergency surgery due to perforation, bleeding, or obstruction, 18 with preoperative radiotherapy or chemotherapy were excluded. The remaining 102 patients, aged 65 years or over, were included in the study. Patient characteristics, intraoperative findings, and postoperative complications were evaluated.
Results:
Postoperative complications with Clavien–Dindo grade ≥ II were observed in 29 patients (28.4%). Univariate analysis showed that the prognostic nutritional index (<45) (odds ratio 0.91; 95% confidence interval, 0.86-0.97; p = 0.004), controlling nutritional status score (≥5) (odds ratio 1.27; 95% confidence interval, 1.09-1.49; p = 0.002), and body mass index (BMI) (≥25 kg/m2) (odds ratio 1.97; 95% confidence interval, 1.00-1.26; p = 0.042) significantly predicted postoperative complications. Multivariate analysis showed that BMI (≥25 kg/m2) (odds ratio 1.18; 95% confidence interval, 1.03-1.34; p = 0.011) significantly predicted postoperative complications.
Conclusion:
The overall postoperative complication risk among older individuals with gastric cancer who underwent curative gastrectomy was significantly higher among high-BMI patients. Perioperative management with a focus on BMI is important in older patients undergoing elective curative gastrectomy.
Anahtar Kelimeler
Gastric cancer Older patients Postoperative complication Risk factor
Kaynakça
- Turkish Statistical Information Service [Internet]. Ankara: Turkish Statistical Information Service; 2022 [cited 2022 Aug 29]. Available from: https://data.tuik.gov.tr/Bulten/Index?p= Istatistiklerle-Yaslilar-2021-45636#:~:text.
- Bray F, Ferlay J, Soerjomataram I, Siegel RL, Torre LA, Jemal A. Global cancer statistics 2018: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries. CA Cancer J Clin. 2018;68(6):394-424.
- Eusebi LH, Zagari RM, Bazzoli F. Epidemiology of Helicobacter pylori infection. Helicobacter. 2019;19(1):1-5.
- Zhang Z, Pereira SL, Luo M, Matheson EM. Evaluation of blood biomarkers associated with risk of malnutrition in older adults: a systematic review and meta-analysis. Nutrients. 2017;9(8):829.
- Bittner R, Butters M, Ulrich M, Uppenbrink S, Beger HG. Total gastrectomy. Updated operative mortality and long-term survival with particular reference to patients older than 70 years of age. Ann Surg. 1996;224(1):37-42.
- Lee KG, Lee HJ, Yang JY, et al. Risk factors associated with complication following gastrectomy for gastric cancer: retrospective analysis of prospectively collected data based on the Clavien-Dindo system. J Gastrointest Surg. 2014;18(7):1269-1277.
- Persiani R, Antonacci V, Biondi A, et al. Determinants of surgical morbidity in gastric cancer treatment. J Am Coll Surg. 2008;207(1):13-19.
- Dindo D, Demartines N, Clavien PA. Classification of surgical complications: a new proposal with evaluation in a cohort of 6336 patients and results of a survey. Ann Surg. 2004;240(2):205-213.
- In H, Solsky I, Palis B, Langdon-Embry M, Ajani J, Sano T. Validation of the 8th edition of the AJCC TNM staging system for gastric cancer using the national cancer database. Ann Surg Oncol. 2017;24(12):3683-91.
- Roukos DH, Kappas AM. Perspectives in the treatment of gastric cancer. Nat Clin Pract Oncol. 2005;2(2):98-107.
- Cerantola Y, Grass F, Cristaudi A, Demartines N, Schäfer M, Hübner M. Perioperative nutrition in abdominal surgery: recommendations and reality. Gastroenterol Res Pract. 2011;2011:739347.
- Buzby GP, Mullen JL, Matthews DC, Hobbs CL, Rosato EF. Prognostic nutritional index in gastrointestinal surgery. Am J Surg. 1983;139:160-167.
- Onodera T, Goseki N, Kosaki G. Prognostic nutritional index in gastrointestinal surgery of malnourished cancer patients. Nippon Geka Gakkai Zasshi. 1984;85(9):1001-1005.
- Takagi K, Domagala P, Polak WG, Buettner S, Ijzermans JNM. The controlling nutritional status score and postoperative complication risk in gastrointestinal and hepatopancreatobiliary surgical oncology: a systematic review and meta-analysis. Ann Nutr Metab. 2019;74(4):303-312.
- Yamanaka T, Matsumoto S, Teramukai S, Ishiwata R, Nagai Y, Fukushima M. The base-line ratio of neutrophils to lymphocytes is as-sociated with patient prognosis in advanced gastric cancer. Oncology. 2007;73(3-4):215-220.
- Tanaka H, Muguruma K, Toyokawa T, Kubo N, Ohira M, Hirakawa K. Differential impact of the neutrophil-lymphocyte ratio on the survival of patients with stage IV gastric cancer. Dig Surg. 2014;31:327-333.
- Sakurai K, Ohira M, Tamura T, et al. Predictive potential of preoperative nutritional status in long-term outcome projections for patients with gastric cancer. Ann Surg Oncol. 2016;23:525-533.
- Wang A, He Z, Cong P, et al. Controlling Nutritional Status (CONUT) Score as a new indicator of prognosis in patients with hilar cholangiocarcinoma is superior to NLR and PNI: A single-center retrospective study. Front Oncol. 2021;10:593452.
- Tsujinaka T, Sasako M, Yamamoto S, et al. Influence of overweight on surgical complications for gastric cancer: results from a randomized control trial comparing D2 and extended para-aortic D3 lymphadenectomy (JCOG9501). Ann Surg Oncol. 2007;14(2):355-361.
- Sørensen LT, Hemmingsen U, Kallehave F, et al. Risk factors for tissue and wound complications in gastrointestinal surgery. Ann Surg. 2005;241(4):654-658.
- Brem H, Tomic-Canic M. Cellular and molecular basis of wound healing in diabetes. J Clin Invest. 2007;117(5):1219-1222.
- Hanley MJ, Abernethy DR, Greenblatt DJ. Effect of obesity on the pharmacokinetics of drugs in humans. Clin Pharmacokinet. 2010;49(2):71-87.
- Kim MG, Yook JH, Kim KC, et al. Influence of obesity on early surgical outcomes of laparoscopic-assisted gastrectomy in gastric cancer. Surg Laparosc Endosc Percutan Tech. 2011;21(3):151-154.
- Kulig J, Sierzega M, Kolodziejczyk P, et al. Polish Gastric Cancer Study Group. Implications of overweight in gastric cancer: a multicenter study in a western patient population. Eur J Surg Oncol. 2010;36(10):969-976.
- Hirao M, Tsujinaka T, Imamura H, et al. Osaka gastrointestinal cancer chemotherapy study group (OGSG). Overweight is a risk factor for surgical site infection following distal gastrectomy for gastric cancer. Gastric Cancer. 2013;16(2):239-244.
- Ejaz A, Spolverato G, Kim Y, et al. Impact of body mass index on perioperative outcomes and survival after resection for gastric cancer. J Surg Res. 2015;195(1):74-82.
- Chen HN, Chen XZ, Zhang WH, et al. The impact of body mass index on the surgical outcomes of patients with gastric cancer: a 10-year, single-institution cohort study. Medicine (Baltimore). 2015;94(42):e1769.
- Bickenbach KA, Denton B, Gonen M, Brennan MF, Coit DG, Strong VE. Impact of obesity on perioperative complications and long-term survival of patients with gastric cancer. Ann Surg Oncol. 2013;20(3):780-787.
- Imai E, Ueda M, Kanao K, et al. Surgical site infection risk factors identified by multivariate analysis for patient undergoing laparoscopic, open colon, and gastric surgery. Am J Infect Control. 2008;36(10):727-731.
- Zhao B, Zhang J, Mei D, et al. Does high body mass index negatively affect the surgical outcome and long‑term survival of gastric cancer patients who underwent gastrectomy: a systematic review and meta‑analysis. Eur J Surg Oncol. 2018;44(12):1971-1981.
- Bickenbach KA, Denton B, Gonen M, Brennan MF, Coit DG, Strong VE. Impact of obesity on perioperative complications and long-term survival of patients with gastric cancer. Ann Surg Oncol. 2013;20(3):780-787.
- Lee JY, Kim HI, Kim YN, et al. Clinical significance of the prognostic nutritional index for predicting short- and long-term surgical outcomes after gastrectomy: a retrospective analysis of 7781 gastric cancer patients. Medicine (Baltimore). 2016;95(18):e3539.
- Migita K, Takayama T, Saeki K, et al. The prognostic nutritional index predicts long-term outcomes of gastric cancer patients independent of tumor stage. Ann Surg Oncol. 2013;20(8):2647-2654.
- Tokunaga R, Sakamoto Y, Nakagawa S, et al. Prognostic nutritional index predicts severe complications, recurrence, and poor prognosis in patients with colorectal cancer undergoing primary tumor resection. Dis Colon Rectum. 2015;58(11):1048-1057.
- Ryo S, Kanda M, Ito S, et al. The controlling nutritional status score serves as a predictor of short- and long-term outcomes for patients with stage 2 or 3 gastric cancer: analysis of a multi-institutional data set. Ann Surg Oncol. 2019; 26(2):456-464.
Altmış beş yaş ve üzeri mide kanserli hastalarda küratif gastrektomi sonrası genel komplikasyonlar için risk faktörlerinin değerlendirilmesi
Öz
Amaç:
Bu çalışmanın amacı, 65 yaş ve üstü mide kanserli hastalarda postoperatif komplikasyonlar için risk faktörlerini belirlemektir.
Yöntem:
Veri tabanımızdaki tıbbi kayıtlardan elde edilen veriler retrospektif olarak gözden geçirildi ve analiz edildi. Kliniğimizde Ocak 2017 ile Aralık 2021 tarihleri arasında mide kanseri tanısı almış, 229 hastaya küratif gastrektomi uygulandı. Altmış beş yaşından küçük olan seksen sekiz; karın cerrahisi, multivisseral rezeksiyon, perforasyon, kanama, tıkanıklık nedeniyle acil cerrahi öyküsü olan 21; preoperatif radyoterapi veya kemoterapi uygulanmış 18 hasta çalışmadan dışlandı. Altmış beş yaş ve üzeri 102 hasta çalışmaya dahil edildi. Hasta özellikleri, intraoperatif bulgular ve postoperatif komplikasyonlar değerlendirildi.
Bulgular:
Yirmi dokuz hastada (%28.4) Clavien–Dindo derecesi ≥ II olan postoperatif komplikasyonlar gözlendi. Tek değişkenli analizlerde, prognostik beslenme indeksinin (<45) (olasılık oranı 0,91; %95 güven aralığı, 0,86-0,97; p = 0,004), kontrol beslenme durum skorunun (≥5) (olasılık oranı 1,27; %95 güven aralığı, 1,09-1,49; p = 0,002) ve vücut kitle indeksinin (VKİ) (≥25 kg/m2) (olasılık oranı 1,97; %95 güven aralığı, 1,00-1,26; p = 0,042) postoperatif komplikasyonları anlamlı şekilde öngördüğü belirlendi. Çok değişkenli analizlerde, VKİ'nin (≥25 kg/m2) (olasılık oranı 1,18; %95 güven aralığı, 1,03-1,34; p = 0,011) postoperatif komplikasyonları önemli ölçüde öngördüğü gösterildi.
Sonuç:
Küratif gastrektomi uygulanan 65 yaş ve üzeri mide kanserli bireylerde genel postoperatif komplikasyon riski, yüksek VKİ'li hastalarda anlamlı olarak daha yüksekti. Elektif küratif gastrektomi geçiren yaşlı hastalarda VKİ'ye odaklanan perioperatif yönetim önemlidir.
Anahtar Kelimeler
Ameliyat sonrası komplikasyon Mide kanseri Risk faktörü Yaşlı hastalar
Kaynakça
- Turkish Statistical Information Service [Internet]. Ankara: Turkish Statistical Information Service; 2022 [cited 2022 Aug 29]. Available from: https://data.tuik.gov.tr/Bulten/Index?p= Istatistiklerle-Yaslilar-2021-45636#:~:text.
- Bray F, Ferlay J, Soerjomataram I, Siegel RL, Torre LA, Jemal A. Global cancer statistics 2018: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries. CA Cancer J Clin. 2018;68(6):394-424.
- Eusebi LH, Zagari RM, Bazzoli F. Epidemiology of Helicobacter pylori infection. Helicobacter. 2019;19(1):1-5.
- Zhang Z, Pereira SL, Luo M, Matheson EM. Evaluation of blood biomarkers associated with risk of malnutrition in older adults: a systematic review and meta-analysis. Nutrients. 2017;9(8):829.
- Bittner R, Butters M, Ulrich M, Uppenbrink S, Beger HG. Total gastrectomy. Updated operative mortality and long-term survival with particular reference to patients older than 70 years of age. Ann Surg. 1996;224(1):37-42.
- Lee KG, Lee HJ, Yang JY, et al. Risk factors associated with complication following gastrectomy for gastric cancer: retrospective analysis of prospectively collected data based on the Clavien-Dindo system. J Gastrointest Surg. 2014;18(7):1269-1277.
- Persiani R, Antonacci V, Biondi A, et al. Determinants of surgical morbidity in gastric cancer treatment. J Am Coll Surg. 2008;207(1):13-19.
- Dindo D, Demartines N, Clavien PA. Classification of surgical complications: a new proposal with evaluation in a cohort of 6336 patients and results of a survey. Ann Surg. 2004;240(2):205-213.
- In H, Solsky I, Palis B, Langdon-Embry M, Ajani J, Sano T. Validation of the 8th edition of the AJCC TNM staging system for gastric cancer using the national cancer database. Ann Surg Oncol. 2017;24(12):3683-91.
- Roukos DH, Kappas AM. Perspectives in the treatment of gastric cancer. Nat Clin Pract Oncol. 2005;2(2):98-107.
- Cerantola Y, Grass F, Cristaudi A, Demartines N, Schäfer M, Hübner M. Perioperative nutrition in abdominal surgery: recommendations and reality. Gastroenterol Res Pract. 2011;2011:739347.
- Buzby GP, Mullen JL, Matthews DC, Hobbs CL, Rosato EF. Prognostic nutritional index in gastrointestinal surgery. Am J Surg. 1983;139:160-167.
- Onodera T, Goseki N, Kosaki G. Prognostic nutritional index in gastrointestinal surgery of malnourished cancer patients. Nippon Geka Gakkai Zasshi. 1984;85(9):1001-1005.
- Takagi K, Domagala P, Polak WG, Buettner S, Ijzermans JNM. The controlling nutritional status score and postoperative complication risk in gastrointestinal and hepatopancreatobiliary surgical oncology: a systematic review and meta-analysis. Ann Nutr Metab. 2019;74(4):303-312.
- Yamanaka T, Matsumoto S, Teramukai S, Ishiwata R, Nagai Y, Fukushima M. The base-line ratio of neutrophils to lymphocytes is as-sociated with patient prognosis in advanced gastric cancer. Oncology. 2007;73(3-4):215-220.
- Tanaka H, Muguruma K, Toyokawa T, Kubo N, Ohira M, Hirakawa K. Differential impact of the neutrophil-lymphocyte ratio on the survival of patients with stage IV gastric cancer. Dig Surg. 2014;31:327-333.
- Sakurai K, Ohira M, Tamura T, et al. Predictive potential of preoperative nutritional status in long-term outcome projections for patients with gastric cancer. Ann Surg Oncol. 2016;23:525-533.
- Wang A, He Z, Cong P, et al. Controlling Nutritional Status (CONUT) Score as a new indicator of prognosis in patients with hilar cholangiocarcinoma is superior to NLR and PNI: A single-center retrospective study. Front Oncol. 2021;10:593452.
- Tsujinaka T, Sasako M, Yamamoto S, et al. Influence of overweight on surgical complications for gastric cancer: results from a randomized control trial comparing D2 and extended para-aortic D3 lymphadenectomy (JCOG9501). Ann Surg Oncol. 2007;14(2):355-361.
- Sørensen LT, Hemmingsen U, Kallehave F, et al. Risk factors for tissue and wound complications in gastrointestinal surgery. Ann Surg. 2005;241(4):654-658.
- Brem H, Tomic-Canic M. Cellular and molecular basis of wound healing in diabetes. J Clin Invest. 2007;117(5):1219-1222.
- Hanley MJ, Abernethy DR, Greenblatt DJ. Effect of obesity on the pharmacokinetics of drugs in humans. Clin Pharmacokinet. 2010;49(2):71-87.
- Kim MG, Yook JH, Kim KC, et al. Influence of obesity on early surgical outcomes of laparoscopic-assisted gastrectomy in gastric cancer. Surg Laparosc Endosc Percutan Tech. 2011;21(3):151-154.
- Kulig J, Sierzega M, Kolodziejczyk P, et al. Polish Gastric Cancer Study Group. Implications of overweight in gastric cancer: a multicenter study in a western patient population. Eur J Surg Oncol. 2010;36(10):969-976.
- Hirao M, Tsujinaka T, Imamura H, et al. Osaka gastrointestinal cancer chemotherapy study group (OGSG). Overweight is a risk factor for surgical site infection following distal gastrectomy for gastric cancer. Gastric Cancer. 2013;16(2):239-244.
- Ejaz A, Spolverato G, Kim Y, et al. Impact of body mass index on perioperative outcomes and survival after resection for gastric cancer. J Surg Res. 2015;195(1):74-82.
- Chen HN, Chen XZ, Zhang WH, et al. The impact of body mass index on the surgical outcomes of patients with gastric cancer: a 10-year, single-institution cohort study. Medicine (Baltimore). 2015;94(42):e1769.
- Bickenbach KA, Denton B, Gonen M, Brennan MF, Coit DG, Strong VE. Impact of obesity on perioperative complications and long-term survival of patients with gastric cancer. Ann Surg Oncol. 2013;20(3):780-787.
- Imai E, Ueda M, Kanao K, et al. Surgical site infection risk factors identified by multivariate analysis for patient undergoing laparoscopic, open colon, and gastric surgery. Am J Infect Control. 2008;36(10):727-731.
- Zhao B, Zhang J, Mei D, et al. Does high body mass index negatively affect the surgical outcome and long‑term survival of gastric cancer patients who underwent gastrectomy: a systematic review and meta‑analysis. Eur J Surg Oncol. 2018;44(12):1971-1981.
- Bickenbach KA, Denton B, Gonen M, Brennan MF, Coit DG, Strong VE. Impact of obesity on perioperative complications and long-term survival of patients with gastric cancer. Ann Surg Oncol. 2013;20(3):780-787.
- Lee JY, Kim HI, Kim YN, et al. Clinical significance of the prognostic nutritional index for predicting short- and long-term surgical outcomes after gastrectomy: a retrospective analysis of 7781 gastric cancer patients. Medicine (Baltimore). 2016;95(18):e3539.
- Migita K, Takayama T, Saeki K, et al. The prognostic nutritional index predicts long-term outcomes of gastric cancer patients independent of tumor stage. Ann Surg Oncol. 2013;20(8):2647-2654.
- Tokunaga R, Sakamoto Y, Nakagawa S, et al. Prognostic nutritional index predicts severe complications, recurrence, and poor prognosis in patients with colorectal cancer undergoing primary tumor resection. Dis Colon Rectum. 2015;58(11):1048-1057.
- Ryo S, Kanda M, Ito S, et al. The controlling nutritional status score serves as a predictor of short- and long-term outcomes for patients with stage 2 or 3 gastric cancer: analysis of a multi-institutional data set. Ann Surg Oncol. 2019; 26(2):456-464.
Ayrıntılar
| Birincil Dil | İngilizce |
|---|---|
| Konular | Gastroenteroloji Cerrahisi |
| Bölüm | Research Articles [en] Araştırma Makaleleri [tr] |
| Yazarlar | |
| Erken Görünüm Tarihi | 26 Ekim 2023 |
| Yayımlanma Tarihi | 27 Ekim 2023 |
| Yayımlandığı Sayı | Yıl 2023 Cilt: 4 Sayı: 5 |
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