Impact of comorbidities on postoperative complications in patients undergoing laparoscopy-assisted gastrectomy for gastric cancer

Abstract

BackgroundComorbidity is a predictor of postoperative complications (PCs) in gastrectomy. However, it remains unclear which comorbidities are predictors of PCs in patients who undergo laparoscopy-assisted gastrectomy (LAG). Clinically, insufficient lymphadenectomy (LND) is sometimes performed in high-risk patients, although the impact on PCs and outcomes remains unclear.MethodsWe retrospectively studied 529 patients with gastric cancer (GC) who underwent LAG. PCs were defined as grade 2 or higher events according to the Clavien-Dindo classification. We evaluated various comorbidities as risk factors for PCs and examined the impact of insufficient LND on PCs in patients with risky comorbidities.ResultA total of 87 (16.4%) patients had PCs. There was no PC-related death. On univariate analysis, heart disease, central nervous system (CNS) disease, liver disease, renal dysfunction, and restrictive pulmonary dysfunction were significantly associated with PCs. Both liver disease and heart disease were significant independent risk factors for PCs on multivariate analysis (odds ratio [OR] = 3.25, p = 0.022; OR = 2.36, p = 0.017, respectively). In patients with one or more risky comorbidity, insufficient LND did not significantly decrease PCs (p = 0.42) or shorten GC-specific survival (p = 0.25).ConclusionIn patients who undergo LAG for GC, the presence of heart disease or liver disease is an independent risk factor for PC. Insufficient LND (for example, D1+ for advanced GC) might be permissible in high-risk patients, because although it did not reduce PCs, it had no negative impact on GC-specific survival.

Multivariable analysis of predictors of unplanned hospital readmission after pancreaticoduodenectomy: development of a validated risk score

“…15,40 In our study, a history of cardiac disease was an independent predictor of readmission. Previous studies have also identified a relationship between cardiac disease and post-operative morbidity and hospital readmission 13,41,42 including a metaanalysis by Fisher et al which evaluated the factors associated with readmission after pancreatic surgery. 43 Although the exact mechanism by which patients with cardiac disease are at risk of readmission is unclear, it is likely that such patients have less capacity to respond to complications due to a lower physiological reserve.…”

Postoperative infection rate and clinical outcome after oncosurgery for endometrial carcinoma in a patient population with high prevalence of multidrug-resistant organism colonization and multiple comorbidities

“…2-4 SSI rates are also influenced by preoperative comorbidities. [5][6][7] In the current study, we report the impact of significant MDR-GNB colonization and concurrent comorbidity on SSI and long-term surgical outcomes.The current retrospective study was conducted among patients operated for endometrial cancer in an oncology center in eastern India between 2011 and 2016. In total, 150 patients underwent gynecological oncosurgery during this period.…”

“…[2][3][4] SSI rates are also influenced by preoperative comorbidities. [5][6][7] In the current study, we report the impact of significant MDR-GNB colonization and concurrent comorbidity on SSI and long-term surgical outcomes.…”

“…In addition, 12 patients (8%) required referral to other departments: radiation oncology, 6 patients; medical oncology, 3 patients; palliative care, 2 patients; general medicine, The presence of preoperative comorbidities and performance scores, such as the ECOG, are often used as predictors of postoperative morbidity and risk stratification before oncosurgical intervention. [5][6][7] Oncosurgery in a population with a high prevalence of 1 or more medical morbidities is difficult and is prone to intraoperative and postoperative complications, including SSI and other infections. Our study demonstrates that various multimodal strategies, such as appropriate patient selection for surgery, MDRO colonization screening, aggressive management of suspected/confirmed infection, early postoperative enteral nutrition, physiotherapy, antibiotic stewardship, and/or wound management, could reduce all-cause mortality, even after radical surgery for endometrial cancer patients, in settings with high rates of MDRO colonization, MDR infection, and other postoperative infections.…”

Clinical significance of lymphadenectomy in patients with gastric cancer

“…D1+ can be an alternate for D2 in highrisk patients [104] . Inokuchi et al [105] suggested that the presence of heart or liver disease is a significant risk factor for postoperative morbidity in patients who undergo laparoscopic gastrectomy. Although it did not reduce complications, insufficient LN dissection (for example, D1+ for advanced gastric cancer) might be permissible in highrisk patients as it had no negative impact on gastric cancerspecific survival.…”