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Ushimaru Y, Nagano S, Kawabata R, Nishikawa K, Takeoka T, Kitagawa A, Ohara N, Tomihara H, Maeda S, Imasato M, Noura S, Miyamoto A. Enhancing surgical outcomes in elderly gastric cancer patients: the role of comprehensive preoperative assessment and support. World J Surg Oncol 2024; 22:136. [PMID: 38778314 PMCID: PMC11112811 DOI: 10.1186/s12957-024-03421-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2024] [Accepted: 05/21/2024] [Indexed: 05/25/2024] Open
Abstract
BACKGROUND As the prevalence of gastric cancer rises in aging populations, managing surgical risks and comorbidities in elderly patients presents a unique challenge. The Comprehensive Preoperative Assessment and Support (CPAS) program, through comprehensive preoperative assessments, aims to mitigate surgical stress and improve outcomes by enhancing patient awareness and preparation. This study investigates the efficacy of a CPAS program, incorporating frailty and sarcopenia evaluations, to improve short-term outcomes in elderly gastric cancer patients. METHODS A retrospective analysis was conducted on 127 patients aged 75 or older who underwent surgery with CPAS between 2018 and August 2023, compared to 170 historical controls from 2012 to 2017. Propensity score matching balanced both groups based on age-adjusted Charlson Comorbidity Index and surgical details. The primary focus was on the impact of CPAS elements such as rehabilitation, nutrition, psychological support, oral frailty, and social support on short-term surgical outcomes. RESULTS Among 83 matched pairs, the CPAS group, despite 40.4% of patients in the CPAS group and 21.2% in the control group had an ASA-PS score of 3 or higher (P < 0.001), demonstrated significantly reduced blood loss (100 ml vs. 190 ml, P = 0.026) and lower incidence of serious complications (19.3% vs. 33.7%, P = 0.034), especially in infections and respiratory issues. Sarcopenia was identified in 38.6% of CPAS patients who received tailored support. Additionally, the median postoperative hospital stay was notably shorter in the CPAS group (10 days vs. 15 days, P < 0.001), with no in-hospital deaths. These results suggest that personalized preoperative care effectively mitigates operative stress and postoperative complications. CONCLUSION Implementing CPAS significantly enhances surgical safety and reduces complication rates in elderly gastric cancer patients, emphasizing the critical role of personalized preoperative care in surgical oncology for this demographic.
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Affiliation(s)
- Yuki Ushimaru
- Department of Gastroenterological Surgery, Sakai City Medical Center, 1-1-1 Ebaraji-Cho, Nishi-Ku, Sakai City, Osaka, 593-8304, Japan
- Department of Gastroenterological Surgery, Osaka International Cancer Institute, Osaka, Japan
- Department of Next Generation Endoscopic Intervention (Project ENGINE), Osaka University Graduate School of Medicine, Osaka, Japan
| | - Shinnosuke Nagano
- Department of Gastroenterological Surgery, Sakai City Medical Center, 1-1-1 Ebaraji-Cho, Nishi-Ku, Sakai City, Osaka, 593-8304, Japan
| | - Ryohei Kawabata
- Department of Gastroenterological Surgery, Sakai City Medical Center, 1-1-1 Ebaraji-Cho, Nishi-Ku, Sakai City, Osaka, 593-8304, Japan.
| | - Kazuhiro Nishikawa
- Department of Gastroenterological Surgery, Sakai City Medical Center, 1-1-1 Ebaraji-Cho, Nishi-Ku, Sakai City, Osaka, 593-8304, Japan
| | - Tomohira Takeoka
- Department of Gastroenterological Surgery, Sakai City Medical Center, 1-1-1 Ebaraji-Cho, Nishi-Ku, Sakai City, Osaka, 593-8304, Japan
| | - Akihiro Kitagawa
- Department of Gastroenterological Surgery, Sakai City Medical Center, 1-1-1 Ebaraji-Cho, Nishi-Ku, Sakai City, Osaka, 593-8304, Japan
| | - Nobuyoshi Ohara
- Department of Gastroenterological Surgery, Sakai City Medical Center, 1-1-1 Ebaraji-Cho, Nishi-Ku, Sakai City, Osaka, 593-8304, Japan
| | - Hideo Tomihara
- Department of Gastroenterological Surgery, Sakai City Medical Center, 1-1-1 Ebaraji-Cho, Nishi-Ku, Sakai City, Osaka, 593-8304, Japan
| | - Sakae Maeda
- Department of Gastroenterological Surgery, Sakai City Medical Center, 1-1-1 Ebaraji-Cho, Nishi-Ku, Sakai City, Osaka, 593-8304, Japan
| | - Mitsunobu Imasato
- Department of Gastroenterological Surgery, Sakai City Medical Center, 1-1-1 Ebaraji-Cho, Nishi-Ku, Sakai City, Osaka, 593-8304, Japan
| | - Shingo Noura
- Department of Gastroenterological Surgery, Sakai City Medical Center, 1-1-1 Ebaraji-Cho, Nishi-Ku, Sakai City, Osaka, 593-8304, Japan
| | - Atsushi Miyamoto
- Department of Gastroenterological Surgery, Sakai City Medical Center, 1-1-1 Ebaraji-Cho, Nishi-Ku, Sakai City, Osaka, 593-8304, Japan
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Ushimaru Y, Nagano S, Nishikawa K, Kawabata R, Takeoka T, Kitagawa A, Ohara N, Tomihara H, Maeda S, Imazato M, Noura S, Miyamoto A. A comprehensive study on non-cancer-related mortality risk factors in elderly gastric cancer patients post-curative surgery. BMC Gastroenterol 2024; 24:78. [PMID: 38373885 PMCID: PMC10875761 DOI: 10.1186/s12876-024-03170-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/07/2023] [Accepted: 02/11/2024] [Indexed: 02/21/2024] Open
Abstract
BACKGROUND The increasing incidence of gastric cancer in the elderly underscores the need for an in-depth understanding of the challenges and risks associated with surgical interventions in this demographic. This study aims to investigate the risk factors and prognostic indicators for non-cancer-related mortality following curative surgery in elderly gastric cancer patients. METHODS This retrospective analysis examined 684 patients with pathological Stage I-III gastric cancer who underwent curative resection between January 2012 and December 2021. The study focused on patients aged 70 years and above, evaluating various clinical and pathological variables. Univariate analysis was utilized to identify potential risk factors with to non-cancer-related mortality and to access prognostic outcomes. RESULTS Out of the initial 684 patients, 244 elderly patients were included in the analysis, with 33 succumbing to non-cancer-related causes. Univariate analysis identified advanced age (≥ 80 years), low body mass index (BMI) (< 18.5), high Charlson Comorbidity Index (CCI), and the presence of overall surgical complications as significant potential risk factors for non-cancer related mortality. These factors also correlated with poorer overall survival and prognosis. The most common cause of non-cancer-related deaths were respiratory issues and heart failure. CONCLUSION In elderly gastric cancer patients, managing advanced age, low BMI, high CCI, and minimizing postoperative complications are essential for reducing non-cancer-related mortality following curative surgery.
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Affiliation(s)
- Yuki Ushimaru
- Department of Gastroenterological Surgery, Sakai City Medical Center, 1-1-1 Ebaraji-Cho, Nishi-Ku, Sakai City, Osaka, 593-8304, Japan.
| | - Shinnosuke Nagano
- Department of Gastroenterological Surgery, Sakai City Medical Center, 1-1-1 Ebaraji-Cho, Nishi-Ku, Sakai City, Osaka, 593-8304, Japan
| | - Kazuhiro Nishikawa
- Department of Gastroenterological Surgery, Sakai City Medical Center, 1-1-1 Ebaraji-Cho, Nishi-Ku, Sakai City, Osaka, 593-8304, Japan
| | - Ryohei Kawabata
- Department of Gastroenterological Surgery, Sakai City Medical Center, 1-1-1 Ebaraji-Cho, Nishi-Ku, Sakai City, Osaka, 593-8304, Japan
| | - Tomohira Takeoka
- Department of Gastroenterological Surgery, Sakai City Medical Center, 1-1-1 Ebaraji-Cho, Nishi-Ku, Sakai City, Osaka, 593-8304, Japan
| | - Akihiro Kitagawa
- Department of Gastroenterological Surgery, Sakai City Medical Center, 1-1-1 Ebaraji-Cho, Nishi-Ku, Sakai City, Osaka, 593-8304, Japan
| | - Nobuyoshi Ohara
- Department of Gastroenterological Surgery, Sakai City Medical Center, 1-1-1 Ebaraji-Cho, Nishi-Ku, Sakai City, Osaka, 593-8304, Japan
| | - Hideo Tomihara
- Department of Gastroenterological Surgery, Sakai City Medical Center, 1-1-1 Ebaraji-Cho, Nishi-Ku, Sakai City, Osaka, 593-8304, Japan
| | - Sakae Maeda
- Department of Gastroenterological Surgery, Sakai City Medical Center, 1-1-1 Ebaraji-Cho, Nishi-Ku, Sakai City, Osaka, 593-8304, Japan
| | - Mitsunobu Imazato
- Department of Gastroenterological Surgery, Sakai City Medical Center, 1-1-1 Ebaraji-Cho, Nishi-Ku, Sakai City, Osaka, 593-8304, Japan
| | - Shingo Noura
- Department of Gastroenterological Surgery, Sakai City Medical Center, 1-1-1 Ebaraji-Cho, Nishi-Ku, Sakai City, Osaka, 593-8304, Japan
| | - Atsushi Miyamoto
- Department of Gastroenterological Surgery, Sakai City Medical Center, 1-1-1 Ebaraji-Cho, Nishi-Ku, Sakai City, Osaka, 593-8304, Japan
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Pang TS, Cao LP. Estimation of Physiologic Ability and Surgical Stress scoring system for predicting complications following abdominal surgery: A meta-analysis spanning 2004 to 2022. World J Gastrointest Surg 2024; 16:215-227. [PMID: 38328319 PMCID: PMC10845291 DOI: 10.4240/wjgs.v16.i1.215] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/31/2023] [Revised: 11/24/2023] [Accepted: 12/19/2023] [Indexed: 01/25/2024] Open
Abstract
BACKGROUND Postoperative complications remain a paramount concern for surgeons and healthcare practitioners. AIM To present a comprehensive analysis of the Estimation of Physiologic Ability and Surgical Stress (E-PASS) scoring system's efficacy in predicting postoperative complications following abdominal surgery. METHODS A systematic search of published studies was conducted, yielding 17 studies with pertinent data. Parameters such as preoperative risk score (PRS), surgical stress score (SSS), comprehensive risk score (CRS), postoperative complications, postoperative mortality, and other clinical data were collected for meta-analysis. Forest plots were employed for continuous and binary variables, with χ2 tests assessing heterogeneity (P value). RESULTS Patients experiencing complications after abdominal surgery exhibited significantly higher E-PASS scores compared to those without complications [mean difference and 95% confidence interval (CI) of PRS: 0.10 (0.05-0.15); SSS: 0.04 (0.001-0.08); CRS: 0.19 (0.07-0.31)]. Following the exclusion of low-quality studies, results remained valid with no discernible heterogeneity. Subgroup analysis indicated that variations in sample size and age may contribute to heterogeneity in CRS analysis. Binary variable meta-analysis demonstrated a correlation between high CRS and increased postoperative complication rates [odds ratio (OR) (95%CI): 3.01 (1.83-4.95)], with a significant association observed between high CRS and postoperative mortality [OR (95%CI): 15.49 (3.75-64.01)]. CONCLUSION In summary, postoperative complications in abdominal surgery, as assessed by the E-PASS scoring system, are consistently linked to elevated PRS, SSS, and CRS scores. High CRS scores emerge as risk factors for heightened morbidity and mortality. This study establishes the accuracy of the E-PASS scoring system in predicting postoperative morbidity and mortality in abdominal surgery, underscoring its potential for widespread adoption in effective risk assessment.
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Affiliation(s)
- Tian-Shu Pang
- Department of General Surgery, Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, Hangzhou 310016, Zhejiang Province, China
| | - Li-Ping Cao
- Department of General Surgery, Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, Hangzhou 310016, Zhejiang Province, China
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Sönmez MR, Aydin İC, Biçer G, Havan N, Sunar AO, Ademoğlu S, Özduman MÖ, Dinçer M, Polat E, Duman M. Perirenal fat thickness as a risk factor for postoperative complications in elective colorectal cancer surgery. Medicine (Baltimore) 2023; 102:e34072. [PMID: 37352080 PMCID: PMC10289549 DOI: 10.1097/md.0000000000034072] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/26/2023] [Revised: 05/31/2023] [Accepted: 06/01/2023] [Indexed: 06/25/2023] Open
Abstract
Visceral obesity is an important factor that increases the risk of complications after colorectal cancer surgery. As calculating visceral fat is difficult and time-consuming, more practical fat measurements that are not time-consuming have been introduced. This study aimed to investigate the effects of perirenal fat thickness on postoperative complications and prognosis in patients undergoing surgery for colorectal cancer. Perirenal fat thickness was measured from the dorsal aspect of the left kidney on preoperative computerized tomography of patients who underwent surgery for colorectal cancer. The effects of perirenal fat thickness on postoperative complications were investigated. Diagnostic test performance was examined using the Roc Curve test to determine the cutoff value for the perirenal fat thickness values according to the complication findings of the patients. The cutoff value of perirenal fat thickness was found to be above 25.1, according to the presence of complications in the patients. Those with a perirenal fat thickness greater than 25.1 mm were considered to have high perirenal fat thickness values, and those with a low perirenal fat thickness value were considered low. Multivariate analysis revealed that increased perirenal fat thickness is an independent risk factor for postoperative complications. We believe that perirenal fat thickness measurement, as an indicator of visceral fat volume, can be used to identify patients at high risk of developing complications after colorectal cancer surgery. This may change the disease management and affect the patient information process.
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Affiliation(s)
- Mehmet Reşit Sönmez
- Gastroenterological Surgery Clinic, University of Health Sciences, Ministry of Health, KartalKosuyolu High Specialization Training and Research Hospital, Istanbul, Turkey
| | - İsa Caner Aydin
- Gastroenterological Surgery Clinic, University of Health Sciences, Ministry of Health, KartalKosuyolu High Specialization Training and Research Hospital, Istanbul, Turkey
| | - Gülşah Biçer
- Department of Radiology, University of Health Sciences, Ministry of Health, KartalKosuyolu High Specialization Training and Research Hospital, Istanbul, Turkey
| | - Nuri Havan
- Department of Radiology, University of Health Sciences, Ministry of Health, KartalKosuyolu High Specialization Training and Research Hospital, Istanbul, Turkey
| | - Ahmet Orhan Sunar
- Gastroenterological Surgery Clinic, University of Health Sciences, Ministry of Health, KartalKosuyolu High Specialization Training and Research Hospital, Istanbul, Turkey
| | - Serkan Ademoğlu
- Gastroenterological Surgery Clinic, University of Health Sciences, Ministry of Health, KartalKosuyolu High Specialization Training and Research Hospital, Istanbul, Turkey
| | - Mehmet Ömer Özduman
- Gastroenterological Surgery Clinic, University of Health Sciences, Ministry of Health, KartalKosuyolu High Specialization Training and Research Hospital, Istanbul, Turkey
| | - Mürşit Dinçer
- Gastroenterological Surgery Clinic, University of Health Sciences, Ministry of Health, KartalKosuyolu High Specialization Training and Research Hospital, Istanbul, Turkey
| | - Erdal Polat
- Gastroenterological Surgery Clinic, University of Health Sciences, Ministry of Health, KartalKosuyolu High Specialization Training and Research Hospital, Istanbul, Turkey
| | - Mustafa Duman
- Gastroenterological Surgery Clinic, University of Health Sciences, Ministry of Health, KartalKosuyolu High Specialization Training and Research Hospital, Istanbul, Turkey
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Eto K, Yoshida N, Iwatsuki M, Iwagami S, Nakamura K, Morita K, Ikeshima S, Horino K, Shimada S, Baba H. Clinical impact of perirenal thickness on short‐ and long‐term outcomes of gastric cancer after curative surgery. Ann Gastroenterol Surg 2022; 6:496-504. [PMID: 35847439 PMCID: PMC9271023 DOI: 10.1002/ags3.12547] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/09/2021] [Revised: 12/18/2021] [Accepted: 01/02/2022] [Indexed: 12/09/2022] Open
Abstract
Background A variety of factors for short‐ and long‐term outcomes have been reported after radical resection for gastric cancer (GC). Obesity and emaciation had been reported to be a cause of poor short‐ and long‐term outcomes with gastrointestinal cancer. However, the indicators are still controversial. The purpose of this study was to evaluate the relationship between perirenal thickness (PT) and short‐ and long‐term outcomes after radical surgery for GC. Methods We analyzed the data of 364 patients with GC who underwent radical surgery. We evaluated the distance from the anterior margin of the quadratus lumborum muscle to the dorsal margin of the left renal pole using computed tomography (CT) as an indicator of PT. The association between PT and clinicopathological factors and short‐ and long‐term outcomes was evaluated. Results The PT data were divided into low, normal, and high groups by gender using the tertile value. We found that the PT low group was 121 patients, normal group was 121 patients, and high group was 122 patients. Multivariate analyses showed that the high PT group was an independent risk factor for a short‐outcome after curative surgery in GC patients (odds ratio 2.163; 95% confidence interval [CI] 1.156–4.046; P = .016). And the low PT group was an independent risk factor for overall survival (hazard ratio 2.488; 95% CI 1.400–4.421; P = .0019) and relapse‐free survival (hazard ratio 2.342; 95% CI 1.349–4.064; P = .0025) after curative surgery in GC patients. Conclusion Perirenal thickness is a simple and useful factor for predicting short‐ and long‐term outcomes after radical surgery for GC.
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Affiliation(s)
- Kojiro Eto
- Department of Gastroenterological Surgery Graduate School of Medical Sciences Kumamoto University Kumamoto Japan
- Department of Surgery Japan Community Health care Organization Kumamoto General Hospital Yatsushiro Japan
| | - Naoya Yoshida
- Department of Gastroenterological Surgery Graduate School of Medical Sciences Kumamoto University Kumamoto Japan
| | - Masaaki Iwatsuki
- Department of Gastroenterological Surgery Graduate School of Medical Sciences Kumamoto University Kumamoto Japan
| | - Shiro Iwagami
- Department of Gastroenterological Surgery Graduate School of Medical Sciences Kumamoto University Kumamoto Japan
| | - Kenichi Nakamura
- Department of Surgery Japan Community Health care Organization Kumamoto General Hospital Yatsushiro Japan
| | - Keisuke Morita
- Department of Surgery Japan Community Health care Organization Kumamoto General Hospital Yatsushiro Japan
| | - Satoshi Ikeshima
- Department of Surgery Japan Community Health care Organization Kumamoto General Hospital Yatsushiro Japan
| | - Kei Horino
- Department of Surgery Japan Community Health care Organization Kumamoto General Hospital Yatsushiro Japan
| | - Shinya Shimada
- Department of Surgery Japan Community Health care Organization Kumamoto General Hospital Yatsushiro Japan
| | - Hideo Baba
- Department of Gastroenterological Surgery Graduate School of Medical Sciences Kumamoto University Kumamoto Japan
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E-PASS scoring system serves as a predictor of short- and long-term outcomes in gastric cancer surgery. Surg Today 2021; 52:914-922. [PMID: 34694494 DOI: 10.1007/s00595-021-02394-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2021] [Accepted: 09/15/2021] [Indexed: 10/20/2022]
Abstract
PURPOSES This study aimed to evaluate the estimation of the physiological ability and surgical stress (E-PASS) scoring system for predicting the short- and long-term outcomes in gastric cancer (GC) surgery. METHODS We analyzed a multi-institutional dataset to study patients who underwent gastrectomy with a curative intent between 2010 and 2014. This study evaluated the associations between the optimal E-PASS score cutoff value and the following outcomes: (1) the incidence of postoperative complications in stage I-III GC patients and (2) the prognosis in stage II-III GC patients. RESULTS A total of 2495 GC patients were included. A cutoff value of 0.419 was determined using the ROC curve analysis. Postoperative complications were observed more frequently in the E-PASS-high group than that in the E-PASS-low group (30% vs. 17%, p < 0.0001). Among pStage II-III GC patients (n = 1009), the overall survival time of the E-PASS-high group was significantly shorter than that of the E-PASS-low group (hazard ratio 2.08; 95% confidence interval 1.64-2.65; p < 0.0001). A forest plot revealed that E-PASS-high was associated with a greater prognostic factor for overall survival in most subgroups. CONCLUSIONS The E-PASS scoring system may therefore be a useful predictor of the short- and long-term outcomes in patients with GC who have undergone radical gastrectomy.
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Hu J, Ma Y, Ma J, Yang Y, Ning Y, Zhu J, Wang P, Chen G, Liu Y. M2 Macrophage-Based Prognostic Nomogram for Gastric Cancer After Surgical Resection. Front Oncol 2021; 11:690037. [PMID: 34458140 PMCID: PMC8397443 DOI: 10.3389/fonc.2021.690037] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2021] [Accepted: 06/29/2021] [Indexed: 12/24/2022] Open
Abstract
A good prediction model is useful to accurately predict patient prognosis. Tumor-node-metastasis (TNM) staging often cannot accurately predict prognosis when used alone. Some researchers have shown that the infiltration of M2 macrophages in many tumors indicates poor prognosis. This approach has the potential to predict prognosis more accurately when used in combination with TNM staging, but there is less research in gastric cancer. A multivariate analysis demonstrated that CD163 expression, TNM staging, age, and gender were independent risk factors for overall survival. Thus, these parameters were assessed to develop the nomogram in the training data set, which was tested in the validation and whole data sets. The model showed a high degree of discrimination, calibration, and good clinical benefit in the training, validation, and whole data sets. In conclusion, we combined CD163 expression in macrophages, TNM staging, age, and gender to develop a nomogram to predict 3- and 5-year overall survivals after curative resection for gastric cancer. This model has the potential to provide further diagnostic and prognostic value for patients with gastric cancer.
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Affiliation(s)
- Jianwen Hu
- Department of General Surgery, Peking University First Hospital, Beijing, China
| | - Yongchen Ma
- Endoscopy Center, Peking University First Hospital, Beijing, China
| | - Ju Ma
- Department of General Surgery, Peking University First Hospital, Beijing, China
| | - Yanpeng Yang
- Department of General Surgery, Peking University First Hospital, Beijing, China
| | - Yingze Ning
- Department of General Surgery, Peking University First Hospital, Beijing, China
| | - Jing Zhu
- Department of General Surgery, Peking University First Hospital, Beijing, China
| | - Pengyuan Wang
- Department of General Surgery, Peking University First Hospital, Beijing, China
| | - Guowei Chen
- Department of General Surgery, Peking University First Hospital, Beijing, China
| | - Yucun Liu
- Department of General Surgery, Peking University First Hospital, Beijing, China
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Kenig J, Mitus JW, Rapacz K, Skorus U, Pietrzyk P, Sega A. Usefulness of scoring systems in outcome prediction for older cancer patients undergoing abdominal surgery. Acta Chir Belg 2020; 120:383-389. [PMID: 31319764 DOI: 10.1080/00015458.2019.1642577] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
BACKGROUND Several postoperative outcome scoring systems have been developed and validated, combining both pre- and intraoperative factors. Among others are the Portsmouth Physiological and Operative Severity Score for the enUmeration of Mortality and morbidity (P-POSSUM), the Estimation of Physiologic Ability and Stress (E-PASS) and the Surgical Apgar Score combined with the American Society of Anesthesiologists physical status classification (SASA). The aim of this study was to compare the above scoring systems in the prediction of 30-day postoperative outcome in older patients with cancer undergoing abdominal surgery. METHODS Consecutive patients ≥70 years were prospectively enrolled. Pre- and intraoperative variables were used to calculate the scores, the ROC and perform logistic regression analysis. RESULTS The study sample comprised 201 patients with a median age of 77 (range 70-93) years. The most common surgical procedure was for colorectal (75%), followed by gastric (10.4%) pancreas (7.0%), gall bladder (3.5%), small bowel (2.5%), and other (1.5%) types of cancer. All scores were independent predictors of 30-day postoperative mortality. In case of 30-day morbidity only SASA turned to be significant. The ROC curves were highly valid and area under the curve showed fair to good discriminatory ability (0.60-0.77) for 30-day postoperative mortality and fair (AUC 0.6) in case of SASA for the 30-day postoperative. CONCLUSION The SASA, E-PASS, and P-POSSUM were confirmed to be predictive of 30-day postoperative mortality in older patients undergoing abdominal elective cancer surgery. Only SASA demonstrated as independent factor predicting postoperative 30-day major morbidity.
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Affiliation(s)
- Jakub Kenig
- Department of General, Oncologic and Geriatric Surgery, Jagiellonian University Medical College, Kraków, Poland
| | - Jerzy W. Mitus
- Department of Surgical Oncology, Centre of Oncology Maria Sklodowska-Curie Memorial Institute, Kraków, Poland
| | - Kamil Rapacz
- Department of General, Oncologic and Geriatric Surgery, Jagiellonian University Medical College, Kraków, Poland
| | - Urszula Skorus
- Department of General, Oncologic and Geriatric Surgery, Jagiellonian University Medical College, Kraków, Poland
| | - Paulina Pietrzyk
- Department of General, Oncologic and Geriatric Surgery, Jagiellonian University Medical College, Kraków, Poland
| | - Aurelia Sega
- Department of Clinical Nursing, Faculty of Health Sciences, Jagiellonian University Collegium Medicum, Kraków, Poland
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Tsuruta A, Watanabe Y, Mineta S, Tanioka H, Nagasaka T, Fujiwara Y, Ueno T. Prognostic Nutritional Index as a Predictor of Postoperative Outcome in Patients Aged 85 Years or Older After Colorectal Cancer Surgery. Indian J Surg 2020. [DOI: 10.1007/s12262-020-02164-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
AbstractThe preoperative prognostic nutritional index (PNI) calculated based on the serum albumin concentration and peripheral blood lymphocyte count has been reported to correlate with the prognosis in patients undergoing cancer surgery. However, in case of very old patients over 85 years old, the value of preoperative PNI in colorectal cancer has not been studied in any detail. The aim of this study was to assess the PNI as a predictor of postoperative outcome in elderly patients over 85 years old with colorectal cancer. We performed a retrospective review in forty-five patients over 85 years old who underwent colorectal tumor resection at our hospital from April 2013 to March 2018. The correlations between preoperative PNI and postoperative complications were examined. The incidence rate of postoperative complications was 31.1% (14/45). All of cases with postoperative complications were improved conservatively. The median preoperative PNI was 43.20 (range 24.05–57.05) in the validation study. According to the receiver operating characteristic (ROC) curve, cutoff value of PNI was set at 45.0 in the validation study. An univariate analysis demonstrated that PNI (p = 0.0006), operation style (elective/emergency) (p = 0.03), operation approach (open/laparoscopy) (p = 0.03), and T factor (p = 0.04). A multivariate analysis showed that PNI was independent predictive factor of postoperative complications. Moreover 3-year overall survival rates of patients in the PNI ≧ 45 and PNI < 45 were 100% and 63.8%, respectively (p = 0.009). This study suggested that PNI is a pivotal independent predictor of the postoperative outcome among elderly patients over 85 years old after colorectal cancer surgery.
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Eto K, Ida S, Ohashi T, Kumagai K, Nunobe S, Ohashi M, Sano T, Hiki N. Perirenal fat thickness as a predictor of postoperative complications after laparoscopic distal gastrectomy for gastric cancer. BJS Open 2020; 4:865-872. [PMID: 32893991 PMCID: PMC7528519 DOI: 10.1002/bjs5.50338] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2020] [Accepted: 06/29/2020] [Indexed: 12/15/2022] Open
Abstract
Background Laparoscopic distal gastrectomy is used widely in surgery for gastric cancer. Excess visceral fat can limit the ability to dissect the suprapancreatic region, potentially increasing the risk of local complications, particularly pancreatic fistula. This study evaluated perirenal fat thickness as a surrogate for visceral fat to see whether this was related to complications after laparoscopic distal gastrectomy. Methods Perirenal fat thickness was measured dorsal to the left kidney as an indicator of visceral fat in patients with gastric cancer who underwent laparoscopic distal gastrectomy. Patients were divided into two groups: those with and those without complications. The relationship between perirenal fat thickness and postoperative complications was evaluated. Results The optimal cut‐off value for predicting morbidity using adipose tissue thickness was 10·7 mm; a distance equal to or greater than this was considered a positive perirenal fat thickness sign (PTS). A positive PTS showed a significant correlation with visceral fat area. Multivariable analysis found that a positive PTS was an independent risk factor for complications (hazard ratio 4·42, 95 per cent c.i. 2·31 to 8·86; P < 0·001). Conclusion Perirenal fat thickness as an indicator of visceral fat was an independent predictor of postoperative complications after laparoscopic distal gastrectomy for gastric cancer.
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Affiliation(s)
- K Eto
- Department of Gastroenterological Surgery, Cancer Institute Hospital, Tokyo
| | - S Ida
- Department of Gastroenterological Surgery, Cancer Institute Hospital, Tokyo
| | - T Ohashi
- Department of Gastroenterological Surgery, Cancer Institute Hospital, Tokyo
| | - K Kumagai
- Department of Gastroenterological Surgery, Cancer Institute Hospital, Tokyo
| | - S Nunobe
- Department of Gastroenterological Surgery, Cancer Institute Hospital, Tokyo
| | - M Ohashi
- Department of Gastroenterological Surgery, Cancer Institute Hospital, Tokyo
| | - T Sano
- Department of Gastroenterological Surgery, Cancer Institute Hospital, Tokyo
| | - N Hiki
- Department of Upper Gastrointestinal Surgery, Kitasato University School of Medicine, Sagamihara City, Kanagawa, Japan
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11
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Kondo H, Hirano Y, Ishii T, Hara K, Obara N, Wang L, Asari M, Kato T, Yamaguchi S. E-PASS Scoring System May Be Useful for Prediction of Postoperative Complications in Super Elderly Colorectal Cancer Surgery Patients. JOURNAL OF THE ANUS RECTUM AND COLON 2020; 4:137-144. [PMID: 32743116 PMCID: PMC7390610 DOI: 10.23922/jarc.2020-017] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/05/2020] [Accepted: 05/22/2020] [Indexed: 02/04/2023]
Abstract
Objectives: Japan is facing an aging society. Elderly individuals are generally more prone to comorbidities and have weaker immune defenses, with ominous prognostic implications if postoperative complications arise. The aim of this study was to explore scoring systems for predicting postoperative morbidity risk in super elderly patients (≥85 years old) after colorectal surgery for cancer. Methods: A population of elderly patients (n = 145) surgically treated for primary colorectal cancer within our department between April 2007 and December 2018 was examined retrospectively, assessing the capacities of various indices, such as Estimation of Physiologic Ability and Surgical Stress (E-PASS), neutrophil/lymphocyte ratio (NLR), platelet/lymphocyte ratio (PLR), prognostic nutritional index (PNI), and modified Glasgow Prognostic Score (mGPS), to predict postoperative complications. Results: NLR, PLR, and mGPS did not differ significantly in the presence or absence of complications, whereas PNI tended to be lower if complications developed. The E-PASS system showed no group-wise differences in preoperative risk score (PRS), but the surgical stress score (SSS) and the comprehensive risk score (CRS; a composite of PRS and SSS) was significantly higher in patients with complications. Based on the cutoff value calculated from the Receiver operating curve (ROC) for the E-PASS CRS (−0.0580), patients were stratified into low-scoring and high-scoring (HSG) groups. Although not significantly different, the overall survival in the HSG tended to be lower by comparison. Conclusions: The E-PASS scoring system may be a useful predictor of postoperative complications in super elderly patients requiring colorectal cancer surgery.
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Affiliation(s)
- Hiroka Kondo
- Department of Gastroenterological Surgery, Saitama Medical University International Medical Center, Hidaka, Japan
| | - Yasumitsu Hirano
- Department of Gastroenterological Surgery, Saitama Medical University International Medical Center, Hidaka, Japan
| | - Toshimasa Ishii
- Department of Gastroenterological Surgery, Saitama Medical University International Medical Center, Hidaka, Japan
| | - Kiyoka Hara
- Department of Gastroenterological Surgery, Saitama Medical University International Medical Center, Hidaka, Japan
| | - Nao Obara
- Department of Gastroenterological Surgery, Saitama Medical University International Medical Center, Hidaka, Japan
| | - Liming Wang
- Department of Gastroenterological Surgery, Saitama Medical University International Medical Center, Hidaka, Japan
| | - Masahiro Asari
- Department of Gastroenterological Surgery, Saitama Medical University International Medical Center, Hidaka, Japan
| | - Takuya Kato
- Department of Gastroenterological Surgery, Saitama Medical University International Medical Center, Hidaka, Japan
| | - Shigeki Yamaguchi
- Department of Gastroenterological Surgery, Saitama Medical University International Medical Center, Hidaka, Japan
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12
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Takahashi R, Nunobe S, Makuuchi R, Ida S, Kumagai K, Ohashi M, Sano T. Survival outcomes of elderly patients with pathological stages II and III gastric cancer following curative gastrectomy. Ann Gastroenterol Surg 2020; 4:433-440. [PMID: 32724887 PMCID: PMC7382424 DOI: 10.1002/ags3.12339] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/22/2020] [Revised: 03/05/2020] [Accepted: 03/29/2020] [Indexed: 12/16/2022] Open
Abstract
AIM Survival outcomes in elderly patients with pathological stages (pStages) II and III gastric cancer remain inadequately elucidated. We retrospectively analyzed outcomes of elderly and nonelderly patients who underwent curative gastrectomy for this cancer and considered clinical results of the Estimation of Physiologic Ability and Surgical Stress (E-PASS) scoring system for prediction. METHODS Among 1041 patients who underwent gastrectomy for pStages II and III gastric cancer between 2008 and 2013 consecutively, 898 patients were enrolled. Of these, 158 patients (17.6%) were elderly and 740 patients (82.4%) were nonelderly. RESULTS Disease-specific survival (DSS) in the elderly group with pStage III cancer was significantly worse than that in the same stage nonelderly group (P = .001), while there was no difference in DSS for pStage II cancer between the groups (P = .45). Overall survival (OS) was significantly worse in elderly patients for both pStages II and III. Elderly patients with pStage II cancer had larger survival gaps between OS and DSS compared with those with pStage III cancer. OS for elderly patients with comprehensive risk score (CRS) > 0.159 was significantly worse than that for elderly patients with CRS ≤ 0.159 in pStage II cancer. CONCLUSIONS Compared with nonelderly patients, different characteristics were observed in the survival outcomes of elderly patients between pStages II and III gastric cancer. The survival gap between OS and DSS of elderly patients was larger in pStage II cancer than in pStage III cancer. The E-PASS scoring system could be a relatively useful predictor in elderly patients.
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Affiliation(s)
- Ryo Takahashi
- Department of Gastroenterological SurgeryCancer Institute HospitalJapanese Foundation for Cancer ResearchTokyoJapan
| | - Souya Nunobe
- Department of Gastroenterological SurgeryCancer Institute HospitalJapanese Foundation for Cancer ResearchTokyoJapan
| | - Rie Makuuchi
- Department of Gastroenterological SurgeryCancer Institute HospitalJapanese Foundation for Cancer ResearchTokyoJapan
| | - Satoshi Ida
- Department of Gastroenterological SurgeryCancer Institute HospitalJapanese Foundation for Cancer ResearchTokyoJapan
| | - Koshi Kumagai
- Department of Gastroenterological SurgeryCancer Institute HospitalJapanese Foundation for Cancer ResearchTokyoJapan
| | - Manabu Ohashi
- Department of Gastroenterological SurgeryCancer Institute HospitalJapanese Foundation for Cancer ResearchTokyoJapan
| | - Takeshi Sano
- Department of Gastroenterological SurgeryCancer Institute HospitalJapanese Foundation for Cancer ResearchTokyoJapan
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13
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Haga Y, Hiki N, Kinoshita T, Ojima T, Nabeya Y, Kuwabara S, Seto Y, Yajima K, Takeuchi H, Yoshida K, Kodera Y, Fujiwara Y, Baba H. Treatment option of endoscopic stent insertion or gastrojejunostomy for gastric outlet obstruction due to gastric cancer: a propensity score-matched analysis. Gastric Cancer 2020; 23:667-676. [PMID: 31982964 DOI: 10.1007/s10120-020-01040-0] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/02/2019] [Accepted: 01/10/2020] [Indexed: 02/07/2023]
Abstract
BACKGROUND There are currently two treatment options for gastric outlet obstruction (GOO) due to gastric cancer, endoscopic stenting and surgical gastrojejunostomy. However, their therapeutic effects have not yet been established. Therefore, the present study was undertaken to examine these effects. METHODS The Japanese Gastric Cancer Association invited its delegates to participate in a retrospective multicenter cohort study on patients with GOO due to gastric cancer who underwent stent therapy or gastrojejunostomy in 2015. RESULTS We obtained data from 85 patients undergoing stent therapy and 94 undergoing gastrojejunostomy from 42 hospitals. Baseline data revealed that stent patients had lower food intake, poorer performance status, and worse prognostic indices than gastrojejunostomy patients. Postoperative food intake and survival times were worse in stent patients than in gastrojejunostomy patients. We performed propensity score matching to select pairs of patients with similar baseline characteristics in the two treatment groups. After matching, the frequency of postoperative complications was significantly less in stent patients (3%, 1/33) than in gastrojejunostomy patients (21%, 7/34; p = 0.03). A low residue or full diet was achieved by 97% of stent patients (32/33) and 97% of gastrojejunostomy patients (33/34) (p = 0.98). Median survival times were 7.8 months in stent patients and 4.0 months in gastrojejunostomy patients (p = 0.38). CONCLUSIONS Propensity score matching demonstrated that endoscopic stent placement resulted in less postoperative morbidity than and a similar food intake and equivalent survival times to gastrojejunostomy. These results suggest the utility of stent therapy.
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Affiliation(s)
- Yoshio Haga
- Department of Surgery, Japan Community Healthcare Organization Amakusa Central General Hospital, 101 Higashi-machi, Amakusa-shi, 8630033, Japan.
| | - Naoki Hiki
- Department of Gastroenterological Surgery, Cancer Institute Hospital of the Japanese Foundation for Cancer Research, Tokyo, Japan
| | - Takahiro Kinoshita
- Gastric Surgery Division, National Cancer Center Hospital East, Kashiwa, Japan
| | - Toshiyasu Ojima
- Second Department of Surgery, School of Medicine, Wakayama Medical University, Wakayama, Japan
| | - Yoshihiro Nabeya
- Division of Esophago-Gastrointestinal Surgery, Chiba Cancer Center, Chiba, Japan
| | - Shirou Kuwabara
- Department of Digestive Surgery, Niigata City General Hospital, Niigata, Japan
| | - Yasuyuki Seto
- Department of Gastrointestinal Surgery, Graduate School of Medicine, University of Tokyo, Tokyo, Japan
| | - Kazuhito Yajima
- Department of Surgery, Sainokuni Higashiomiya Medical Center, Saitamashi, Japan
| | - Hiroya Takeuchi
- Department of Surgery, Hamamatsu University School of Medicine, Hamamatsu, Japan
| | - Kazuhiro Yoshida
- Department of Surgical Oncology, Gifu University Graduate School of Medicine, Gifu, Japan
| | - Yasuhiro Kodera
- Department of Gastroenterological Surgery, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Yoshiyuki Fujiwara
- Department, of Surgery, School of Medicine, Tottori University Faculty of Medicine, Yonago, Japan
| | - Hideo Baba
- Department of Gastroenterological Surgery, Graduate School of Medical Sciences, Kumamoto University, Kumamoto, Japan
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14
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Lee JG, Kim SA, Eun CS, Han DS, Kim YS, Choi BY, Song KS, Kim HJ, Park CH. Impact of age on stage-specific mortality in patients with gastric cancer: A long-term prospective cohort study. PLoS One 2019; 14:e0220660. [PMID: 31369631 PMCID: PMC6675285 DOI: 10.1371/journal.pone.0220660] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2019] [Accepted: 07/20/2019] [Indexed: 12/31/2022] Open
Abstract
Controversies exist regarding the impact of age on gastric cancer-related mortality according to cancer stage. In our prospective cohort study, we evaluated the impact of age on stage-specific mortality in patients with gastric cancer. Between 2002 and 2006, patients with newly diagnosed gastric cancer were recruited from two university-affiliated hospitals in Korea. Follow-up data were updated regularly based on medical records and telephone surveys. Patients were classified into four subgroups according to age: <50, 50-59, 60-69, and 70-79 years. A total of 448 patients were followed up for 81.6 months (interquartile range, 25.0-139.3 months). The number of patients with stage I, II, III, and IV disease was 247, 74, 88, and 39, respectively. Overall, age was an independent risk factor for gastric cancer-specific mortality (hazard ratio [HR], [95% confidence interval (CI)]: 1.53 [0.91-2.57], 1.88 [1.21-2.91], and 2.64 [1.69-4.14] in the 50-59, 60-69, and 70-79 years groups, respectively, with the <50 years group as reference). In patients with stage I and II gastric cancer, the 70-79 years group was associated with a significantly higher rate of cancer-specific mortality than the <50 years group (stage I: HR [95% CI], 9.55 [2.11-43.12]; stage II: HR [95% CI], 7.17 [2.32-22.18]). However, age was not an independently associated factor for cancer-specific mortality in patients with stage III and IV gastric cancer. Although age was an independent risk factor for gastric cancer-related mortality in patients with gastric cancer, its impact may differ depending on the stage of cancer.
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Affiliation(s)
- Jae Gon Lee
- Department of Internal Medicine, Hanyang University Guri Hospital, Hanyang University College of Medicine, Guri, Korea
| | - Shin Ah Kim
- Department of Food and Nutrition, Gangneung-Wonju National University, Gangneung, Korea
| | - Chang Soo Eun
- Department of Internal Medicine, Hanyang University Guri Hospital, Hanyang University College of Medicine, Guri, Korea
| | - Dong Soo Han
- Department of Internal Medicine, Hanyang University Guri Hospital, Hanyang University College of Medicine, Guri, Korea
| | - Yong Sung Kim
- Genome Editing Research Center, Korea Research Institute of Bioscience and Biotechnology (KRIBB), Daejeon, Korea
- Korea & Department of Functional Genomics, University of Science and Technology (UST), Daejeon, Korea
| | - Bo Youl Choi
- Department of Preventive Medicine, Hanyang University College of Medicine, Seoul, Korea
| | - Kyu Sang Song
- Department of Pathology, College of Medicine, Chungnam National University, Daejeon, Korea
| | - Hyun Ja Kim
- Department of Food and Nutrition, Gangneung-Wonju National University, Gangneung, Korea
- * E-mail: (HJK); (CHP)
| | - Chan Hyuk Park
- Department of Internal Medicine, Hanyang University Guri Hospital, Hanyang University College of Medicine, Guri, Korea
- * E-mail: (HJK); (CHP)
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15
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Surgical treatment outcomes of patients with T1-T2 gastric cancer: does the age matter when excellent treatment results are expected? World J Surg Oncol 2018; 16:79. [PMID: 29661204 PMCID: PMC5902993 DOI: 10.1186/s12957-018-1388-4] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2017] [Accepted: 04/10/2018] [Indexed: 12/30/2022] Open
Abstract
BACKGROUND The proportion of early gastric cancer stages is increasing, as is the incidence of gastric cancer among the elderly population. Therefore, this study was designed to analyze surgical treatment outcomes of T1-T2 gastric cancer in elderly patients. METHODS A total of 457 patients with T1-T2 gastric cancer who underwent gastrectomy between 2005 and 2015 were enrolled in this retrospective study. Patients were classified into two groups according to age (< 70 years versus ≥ 70 years). Clinicopathological features, surgical treatment results, and clinical outcomes were compared between the groups. RESULTS Higher ASA score (ASA 3/4), differentiated cancer, and intestinal-type tumors were more common in elderly patients. Postoperative complication rates were similar between the two groups; however, postoperative mortality rates were significantly higher in the elderly group. Higher ASA score was independently associated with postoperative complications in the elderly group. Furthermore, severe postoperative complications were found as an independent factor associated with higher 90-day mortality rate. Elderly patients had a significantly poorer 5-year overall survival rate. Two surgery-related factors-total gastrectomy and complicated postoperative course-were revealed as independent prognostic factors for poor overall survival in the elderly group. CONCLUSIONS Despite higher postoperative mortality rate and poorer overall survival results, elderly patients with gastric cancer should be considered for radical surgery. ASA score may be useful for predicting surgical treatment outcomes in elderly patients undergoing surgery for GC and hence assists clinicians in planning treatment strategies for each individual patient.
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16
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Kunisaki C, Miyata H, Konno H, Saze Z, Hirahara N, Kikuchi H, Wakabayashi G, Gotoh M, Mori M. Modeling preoperative risk factors for potentially lethal morbidities using a nationwide Japanese web-based database of patients undergoing distal gastrectomy for gastric cancer. Gastric Cancer 2017; 20:496-507. [PMID: 27553666 DOI: 10.1007/s10120-016-0634-0] [Citation(s) in RCA: 39] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/29/2016] [Accepted: 08/08/2016] [Indexed: 02/07/2023]
Abstract
BACKGROUND Most risk models for mortality and morbidity after distal gastrectomy have been created based on relatively small retrospective studies, and a model originating from nationwide database has been lacking. This study aimed to identify preoperative risk factors that predict the postoperative morbidities closely associated with mortality in gastric cancer patients undergoing distal gastrectomy, using data from the National Clinical Database (NCD), a nationwide web-based database in Japan. METHODS We analyzed records from the NCD for 65,906 patients who underwent distal gastrectomy in 1,986 hospitals during 2011 and 2012. Using 80 % of these patients, we identified independent preoperative predictors for morbidities closely related with mortality. These risk factors were then validated using the remaining 20 % of patients from 2011 to 2012 and the further 35,575 records from 2013. RESULTS Operative mortality was 1.07 % and overall morbidity was 14.2 % for the development data set. We selected eight morbidities that were closely associated with postoperative mortality, and then identified between 13 and 25 independent preoperative risk factors for each of the eight morbidities. Of these, old age, female gender, and poor ADL were the factors most frequently associated with the morbidities. The C-indices for each morbidity from the 2011 to 2012 validation data set were favorable as follows: unplanned intubation (0.797), pneumonia (0.784), systemic sepsis (0.748), renal failure (0.832), cardiac events (0.728), large blood transfusions (0.700), central nervous system (CNS) events (0.779), and anastomotic leakage (0.658). Similar C-indices were obtained for each mortality using the 2013 validation data set. CONCLUSIONS In this study, we successfully constructed an acceptable risk model using preoperative risk factors to predict eight postoperative morbidities highly associated with mortality in gastric cancer patients. This risk model could help to tailor perioperative management and improve clinical outcomes for patients who undergo distal gastrectomy.
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Affiliation(s)
- Chikara Kunisaki
- The Japanese Society of Gastroenterological Surgery, Working Group Database Committee, Tokyo, Japan.
- Department of Surgery, Gastroenterological Center, Yokohama City University, 4-57 Urafune-cho, Minami-ku, Yokohama, 232-0024, Japan.
| | - Hiroaki Miyata
- The Japanese Society of Gastroenterological Surgery, Database Committee, Tokyo, Japan
- National Clinical Database, Tokyo, Japan
| | - Hiroyuki Konno
- The Japanese Society of Gastroenterological Surgery, Working Group Database Committee, Tokyo, Japan
- The Japanese Society of Gastroenterological Surgery, Database Committee, Tokyo, Japan
| | - Zenichiro Saze
- The Japanese Society of Gastroenterological Surgery, Working Group Database Committee, Tokyo, Japan
| | - Norimichi Hirahara
- The Japanese Society of Gastroenterological Surgery, Database Committee, Tokyo, Japan
- National Clinical Database, Tokyo, Japan
| | - Hirotoshi Kikuchi
- The Japanese Society of Gastroenterological Surgery, Working Group Database Committee, Tokyo, Japan
| | - Go Wakabayashi
- The Japanese Society of Gastroenterological Surgery, Working Group Database Committee, Tokyo, Japan
- The Japanese Society of Gastroenterological Surgery, Database Committee, Tokyo, Japan
| | - Mitsukazu Gotoh
- The Japanese Society of Gastroenterological Surgery, Working Group Database Committee, Tokyo, Japan
- The Japanese Society of Gastroenterological Surgery, Database Committee, Tokyo, Japan
- National Clinical Database, Tokyo, Japan
| | - Masaki Mori
- The Japanese Society of Gastroenterological Surgery, Tokyo, Japan
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17
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Shimada H, Fukagawa T, Haga Y, Oba K. Does postoperative morbidity worsen the oncological outcome after radical surgery for gastrointestinal cancers? A systematic review of the literature. Ann Gastroenterol Surg 2017; 1:11-23. [PMID: 29863169 PMCID: PMC5881350 DOI: 10.1002/ags3.12002] [Citation(s) in RCA: 81] [Impact Index Per Article: 11.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/09/2016] [Accepted: 02/18/2017] [Indexed: 01/01/2023] Open
Abstract
PURPOSE The impact of postoperative complications on survival after radical surgery for esophageal, gastric, and colorectal cancers remains controversial. We conducted a systematic review of recent publications to examine the effect of postoperative complications on oncological outcome. METHODS A literature search of PubMed/MEDLINE was performed using the keywords "esophageal cancer," "gastric cancer," and "colorectal cancer," obtaining 27 reports published online up until the end of April 2016. Articles focusing on (i) postoperative morbidity and oncological outcome; and (ii) body mass index (BMI), postoperative morbidity, and oncological outcome, were selected. Univariate and multivariate analyses (Cox proportional hazards model) were performed. RESULTS Patients with postoperative complications had significantly poorer long-term survival than those without complications. Complications were associated with impaired oncological outcomes. The hazard ratios for overall survival were 1.67 (95% confidence interval [CI], 1.31-2.12), 1.59 (95% CI, 1.13-2.24), and 1.55 (95% CI, 1.28-1.87) in esophageal, gastric, and colorectal cancers, respectively. High BMI was associated with postoperative morbidity rate but not with poor oncological outcome. Low BMI was significantly associated with inferior oncological outcome. CONCLUSIONS Complications after radical surgery for esophageal, gastric, and colorectal cancers are associated with patient prognosis. Avoiding such complications might improve the outcomes.
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Affiliation(s)
- Hideaki Shimada
- Department of SurgeryToho University School of MedicineTokyoJapan
| | - Takeo Fukagawa
- Gastric Surgery DivisionNational Cancer Center HospitalTokyoJapan
| | - Yoshio Haga
- Department of SurgeryNational Hospital Organization Kumamoto Medical CenterKumamotoJapan
- Department of International Medical CooperationGraduate School of Medical Sciences Kumamoto UniversityKumamotoJapan
| | - Koji Oba
- Department of BiostatisticsSchool of Public HealthGraduate School of MedicineThe University of TokyoTokyoJapan
- Interfaculty Initiative in Information StudiesGraduate School of Interdisciplinary Information StudiesThe University of TokyoTokyoJapan
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Yoshikawa K, Shimada M, Higashijima J, Nakao T, Nishi M, Kashihara H, Takasu C. Limited lymph node dissection in elderly patients with gastric cancer. THE JOURNAL OF MEDICAL INVESTIGATION 2017; 63:91-5. [PMID: 27040060 DOI: 10.2152/jmi.63.91] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
BACKGROUND The number of elderly patients with gastric cancer is continuing to increase along with the life expectancy of the general population. The purpose of this study was to investigate both the impact of age on postoperative outcome and the effect of limited lymph node dissection for elderly patients. METHODS Patients were classified into the following three groups: Group A, ≥80 years old (n=44); Group B, 70-80 years old (n=139); Group C, <70 years old (n=219). Postoperative complication and survival rates were compared between the three groups Results: Limited lymph node dissection was performed significantly more frequently in Group A. In terms of surgery-related complications, no significant difference was seen between groups. In terms of general related complications, the complication rate increased with age, from 4% in Group C to 13% in Group B and 14% in Group A (p<0.05 each). Although limited lymph node dissection was frequently performed in Group A, cancer-specific survival showed no significant difference in R0 patients. CONCLUSIONS Limited lymph node dissection for gastric cancer did not affect the cancer-specific survival in elderly patients.
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Ruspi L, Galli F, Pappalardo V, Inversini D, Martignoni F, Boni L, Dionigi G, Rausei S. Lymphadenectomy in elderly/high risk patients: should it be different? Transl Gastroenterol Hepatol 2017; 2:5. [PMID: 28217755 DOI: 10.21037/tgh.2016.12.07] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/13/2016] [Accepted: 12/27/2016] [Indexed: 12/26/2022] Open
Abstract
The global aging of population will lead a greater number of elderly patients to undergo surgical procedure in a near future. Concerning gastric cancer, the impact of lymphadenectomy on survival has been demonstrated in RCTs, and extended lymphadenectomy is now considered as gold standard of treatment in non-early tumors. However, the role of age as a prognostic factor and the benefit of extended surgery in elderly/high-risk patients are not clearly defined yet. From our revision of literature, it seems that surgery for gastric cancer may have a further tailorization, considering not only the stage of disease, but also patients' age and comorbidities.
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Affiliation(s)
- Laura Ruspi
- Department of General Surgery, University of Insubria, 21100 Varese, Italy; Department of Surgical Sciences, University of Insubria, 21100 Varese, Italy
| | - Federica Galli
- Department of General Surgery, University of Insubria, 21100 Varese, Italy; Department of Surgical Sciences, University of Insubria, 21100 Varese, Italy
| | - Vincenzo Pappalardo
- Department of General Surgery, University of Insubria, 21100 Varese, Italy; Department of Surgical Sciences, University of Insubria, 21100 Varese, Italy
| | - Davide Inversini
- Department of General Surgery, University of Insubria, 21100 Varese, Italy; Department of Surgical Sciences, University of Insubria, 21100 Varese, Italy
| | - Francesco Martignoni
- Department of General Surgery, University of Insubria, 21100 Varese, Italy; Department of Surgical Sciences, University of Insubria, 21100 Varese, Italy
| | - Luigi Boni
- Department of General Surgery, University of Insubria, 21100 Varese, Italy; Department of Surgical Sciences, University of Insubria, 21100 Varese, Italy
| | - Gianlorenzo Dionigi
- Department of General Surgery, University of Insubria, 21100 Varese, Italy; Department of Surgical Sciences, University of Insubria, 21100 Varese, Italy
| | - Stefano Rausei
- Department of General Surgery, University of Insubria, 21100 Varese, Italy; Department of Surgical Sciences, University of Insubria, 21100 Varese, Italy
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Miyakita H, Sadahiro S, Saito G, Okada K, Tanaka A, Suzuki T. Risk scores as useful predictors of perioperative complications in patients with rectal cancer who received radical surgery. Int J Clin Oncol 2016; 22:324-331. [PMID: 27783239 PMCID: PMC5378746 DOI: 10.1007/s10147-016-1054-1] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2016] [Accepted: 10/09/2016] [Indexed: 01/15/2023]
Abstract
BACKGROUND Rectal cancer is associated with a higher rate of surgical complications. The ability to predict the risk of complications before treatment would facilitate the design of personalized treatment strategies optimally suited for each patient. METHODS We retrospectively studied 260 patients with rectal cancer who underwent radical surgery to examine the relations between complications and 5 types of risk scores. RESULTS Complications developed in 56 patients (21.5%). Nineteen patients had infectious complications, 16 had intestinal obstruction, and 12 had other complications. Twelve patients out of 187 patients who received low anterior resection had anastomotic leakage. Estimation of Physiologic Ability and Surgical Stress Comprehensive Risk Score (E-PASS CRS) and Neutrophil-to-lymphocyte Ratio (NLR) were significantly related to all complications, infectious complications, and anastomotic leakage. Surgical Apgar Score was significantly related to infectious complications. Prognostic Nutritional Index was significantly related to all complications and intestinal obstruction. Colorectal Physiologic and Operative Severity Score for the Enumeration of Mortality and Morbidity was significantly related to all complications, and infectious complications. A multivariate analysis showed that body-mass index, E-PASS CRS, and NLR were independent risk factors for anastomotic leakage. In particular, NLR was the only score that could be evaluated before surgery. CONCLUSIONS Five types of risk scores were useful methods for evaluating the risks of complications in patients with rectal cancer. NLR is a score that can be evaluated before surgery and predicted the risk of anastomotic leakage, suggesting that it is useful for assessing the need for a diverting colostomy.
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Affiliation(s)
- Hiroshi Miyakita
- Department of Surgery, School of Medicine, Tokai University, 143 Shimokasuya, Isehara, Kanagawa, 259-1193, Japan
| | - Sotaro Sadahiro
- Department of Surgery, School of Medicine, Tokai University, 143 Shimokasuya, Isehara, Kanagawa, 259-1193, Japan.
| | - Gota Saito
- Department of Surgery, School of Medicine, Tokai University, 143 Shimokasuya, Isehara, Kanagawa, 259-1193, Japan
| | - Kazutake Okada
- Department of Surgery, School of Medicine, Tokai University, 143 Shimokasuya, Isehara, Kanagawa, 259-1193, Japan
| | - Akira Tanaka
- Department of Surgery, School of Medicine, Tokai University, 143 Shimokasuya, Isehara, Kanagawa, 259-1193, Japan
| | - Toshiyuki Suzuki
- Department of Surgery, School of Medicine, Tokai University, 143 Shimokasuya, Isehara, Kanagawa, 259-1193, Japan
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Estimation of Physiologic Ability and Surgical Stress (E-PASS) versus modified E-PASS for prediction of postoperative complications in elderly patients who undergo gastrectomy for gastric cancer. Int J Clin Oncol 2016; 22:80-87. [DOI: 10.1007/s10147-016-1028-3] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2016] [Accepted: 07/28/2016] [Indexed: 11/26/2022]
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E-PASS score as a useful predictor of postoperative complications and mortality after colorectal surgery in elderly patients. Int J Colorectal Dis 2016; 31:217-25. [PMID: 26607908 DOI: 10.1007/s00384-015-2456-7] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/19/2015] [Indexed: 02/04/2023]
Abstract
PURPOSE The aim of this study was to clarify whether a surgical-specific risk scoring system estimating the physiologic ability and surgical stress (E-PASS) score was useful for prediction of postoperative morbidity and mortality. METHODS The E-PASS score consists of the preoperative risk score (PRS), surgical stress score (SSS), and the comprehensive risk score (CRS). Conventional scoring systems [colorectal physiologic and operative severity score for the enumeration of mortality (CR-POSSUM) and the prognostic nutritional index (PNI)] were also examined. We retrospectively compared these scores in patients with or without postoperative complications. We assessed the relationship between these scores, clinicopathological features and postoperative mortality. RESULTS Postoperative complications developed in 78 patients (33%). American Society of Anesthesiologists score, performance status, PNI score, PRS, SSS, and CRS were significantly higher in patients with postoperative complications than in those without postoperative complications (p < 0.05). The area under the receiver operating characteristic curve (AUC) was highest for E-PASS [E-PASS (PRS, 0.74; SSS, 0.62; CRS, 0.78), PNI (0.62), CR-POSSUM (PS, 0.57; OSS, 0.52)]. Multivariate logistic analysis identified CRS ≥ 0.2 as a significant determinant of postoperative complications (p < 0.01; hazard ratio, 4.84). Overall survival was significantly better in the CRS < 0.2 group than in the CRS > 0.2 group (p < 0.01). CONCLUSIONS The E-PASS score system was a useful predictor of postoperative complications and mortality, especially in patients with advanced age.
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Nienhueser H, Kunzmann R, Sisic L, Blank S, Strowitzk MJ, Bruckner T, Jäger D, Weichert W, Ulrich A, Büchler MW, Ott K, Schmidt T. Surgery of gastric cancer and esophageal cancer: Does age matter? J Surg Oncol 2015; 112:387-95. [PMID: 26303645 DOI: 10.1002/jso.24004] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2015] [Accepted: 07/26/2015] [Indexed: 12/29/2022]
Abstract
INTRODUCTION In the past, elderly patients with upper GI cancers were excluded from surgery or multimodal treatment only due to their advanced age. In an aging society this way of patient selection seems to be questionable. The aim of this retrospective exploratory study was to investigate how patients with upper GI cancer over the age of 70 years differ from younger patients in the postoperative course and which parameters influence overall survival in older patient populations. PATIENTS AND METHODS From 2002 to 2012 1,005 patients underwent resection of esophageal or gastric cancer at the University of Heidelberg. 272 patients were older than 70 years and analyzed in subgroups (70-74 years: n = 146; 75-79 years: n = 82; 80 years or older: n = 44). Patients older than 70 years were compared to patients under 70 years (n = 733) with focus on differences in patients characteristics and outcome. Statistical analyses were made retrospectively on a prospective database. RESULTS Fewer older patients were treated neoadjuvantly (< 70 years: 41.5%; > 70 years: 24.7%, P < 0.001) and extended resection (abdominothoracic approach) was applied less frequently compared to patients under 70 years (< 70 years: 38.9%; > 70 years: 19.9%, P < 0.001). The pNM-category (HR 1.41/2.56) and R-status (HR 1.78) remain the most important predictive factor for survival (all < 0.001). Female patients had a longer survival than men over the age of 70 (84.9 vs. 23.5 months, P < 0.01). Patients over 80 years had a significant shortened overall survival (> 80 years: 16.7 vs. < 70 years: 37.4 months) compared to the other subgroups (P < 0.001) and a significant increased in-hospital mortality (> 80 years: 20.5% vs. < 70 years: 6.0%, P = 0.002). CONCLUSIONS An exclusion from surgical therapy due to advanced age in general seems not to be justified. However, the decision for a surgical resection in patients over 80 years should be made with caution. pNM-categories and R0-resection remain the most important predictive factors for overall survival in all subgroups. No survival benefit for neoadjuvant treatment in patients over 70 years was found, while women survived longer than men. However, the decision concerning a (radio) chemotherapy should be made individually in each patient.
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Affiliation(s)
- Henrik Nienhueser
- Department of General, Visceral and Transplant Surgery, University of Heidelberg, Heidelberg, Germany
| | - Romy Kunzmann
- Department of General, Visceral and Transplant Surgery, University of Heidelberg, Heidelberg, Germany
| | - Leila Sisic
- Department of General, Visceral and Transplant Surgery, University of Heidelberg, Heidelberg, Germany
| | - Susanne Blank
- Department of General, Visceral and Transplant Surgery, University of Heidelberg, Heidelberg, Germany
| | - Moritz J Strowitzk
- Department of General, Visceral and Transplant Surgery, University of Heidelberg, Heidelberg, Germany
| | - Thomas Bruckner
- Institute of Medical Biometry and Infomatics IMBI, University of Heidelberg, Heidelberg, Germany
| | - Dirk Jäger
- Department of Medical Oncology, National Center of Tumor Diseases (NCT), University Hospital Heidelberg, Heidelberg, Germany
| | - Wilko Weichert
- Department of Pathology, University of Heidelberg, Heidelberg, Germany
| | - Alexis Ulrich
- Department of General, Visceral and Transplant Surgery, University of Heidelberg, Heidelberg, Germany
| | - Markus W Büchler
- Department of General, Visceral and Transplant Surgery, University of Heidelberg, Heidelberg, Germany
| | - Katja Ott
- Department of General, Vascular and Thoracic Surgery, RoMed Klinikum Rosenheim, Rosenheim, Germany
| | - Thomas Schmidt
- Department of General, Visceral and Transplant Surgery, University of Heidelberg, Heidelberg, Germany
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Postoperative complications in elderly patients with gastric cancer. J Surg Res 2015; 198:317-26. [PMID: 26033612 DOI: 10.1016/j.jss.2015.03.095] [Citation(s) in RCA: 53] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2015] [Revised: 03/10/2015] [Accepted: 03/27/2015] [Indexed: 12/18/2022]
Abstract
BACKGROUND Elderly patients undergoing gastrectomy are expected to be at high risk of postoperative complications. This retrospective multicenter cohort study assessed complications and long-term outcomes after gastrectomy for gastric cancer (GC). METHODS A total of 993 patients with GC who had undergone gastrectomy were included, comprising 186 elderly patients (age ≥ 80 y, E group) and 807 nonelderly patients (age ≤ 79 y, NE group). Preoperative comorbidities, operative results, postoperative complications, and clinical outcomes were compared between the groups. RESULTS Clavien-Dindo grade ≥1 postoperative complications, pneumonia (P = 0.02), delirium (P < 0.001), and urinary tract infection (P < 0.001) were more common in the E group. Postoperative pneumonia was associated with mortality in this group (P < 0.001). Three patients (1.6%) died after surgery, each of whom had pneumonia. Severe postoperative complication was independently prognostic of overall (hazard ratio, 4.69; 95% confidence interval, 2.40-9.14; P < 0.001) and disease-specific (hazard ratio, 6.41; 95% confidence interval 2.92-14.1; P < 0.001) survival in the E group. CONCLUSIONS In elderly patients with GC, clinical outcomes are strongly associated with severe postoperative complications. Preventing such complications may improve survival.
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Ariake K, Yokoyama S, Doi T, Takemura S, Kajiwara T, Kuroda F. Effect of omentum removal on the risk for postoperative adhesive small bowel obstruction recurrence: A case-control study. Int J Surg 2015; 13:27-32. [DOI: 10.1016/j.ijsu.2014.11.031] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2014] [Revised: 11/26/2014] [Accepted: 11/29/2014] [Indexed: 01/17/2023]
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