Impact of Various Types of Comorbidities on the Outcomes of Laparoscopic Total Gastrectomy in Patients with Gastric Carcinoma

Abstract

PurposeWith increasing life expectancy, the presence of comorbidities has become a major concern in elderly patients who require surgery. However, little is known about the impact of different comorbidities on the outcomes of laparoscopic total gastrectomy (LTG). In this study, we investigated the impact of comorbidities on postoperative complications in patients undergoing LTG for gastric carcinoma.Materials and MethodsWe retrospectively reviewed the cases of 303 consecutive patients who underwent LTG for gastric carcinoma between 2005 and 2016. The associations between each comorbidity and postoperative complications were assessed using univariate and multivariate analyses.ResultsA total of 189 patients (62.4%) had one or more comorbidities. Hypertension was the most common comorbidity (37.0%), followed by diabetes mellitus (17.8%), chronic viral hepatitis (2.6%), liver cirrhosis (2.6%), and pulmonary (27.1%), ischemic heart (3.3%), and cerebrovascular diseases (2.3%). The overall postoperative morbidity and mortality rates were 20.1% and 1.0%, respectively. Patients with pulmonary disease significantly showed higher complication rates than those without comorbidities (32.9% vs. 14.9%, respectively, P=0.003); patient with other comorbidities showed no significant difference in the incidence of LTG-related complications. During univariate and multivariate analyses, pulmonary disease was found to be an independent predictive factor for postoperative complications (odds ratio, 2.14; 95% confidence interval, 1.03–4.64), along with old age and intraoperative bleeding.ConclusionsAmong the various comorbidities investigated, patients with pulmonary disease had a significantly higher risk of postoperative complications after LTG. Proper perioperative care for optimizing pulmonary function may be required for patients with pulmonary disease.

Real-Life Use of Ramucirumab in Gastric Cancer in Spain: the RAMIS Study

“…As occurs with other real-life studies, its broader inclusion criteria with respect to Phase III trials [12,13] allow the generation of evidence in patients not represented or underrepresented in the latter, such as patients with comorbidities. Although some baseline characteristics in the RAMIS study were similar to patients participating in clinical trials regarding mean values of age, gender, AGC diagnosis with primary tumor still present and percentage of patients with ECOG 1, in general, the patient population in the present study had a worse prognosis, with a higher presence of proven risk factors such as ECOG 2/3, peritoneal metastases, clinically relevant chronic comorbidities (e.g., hypertension, dyslipidemia), weight loss >10% and nonmeasurable disease [19].…”

Mid- and Long-Term Outcomes of Totally Laparoscopic Gastrectomy for Gastric Cancer. Prospective Study

“…The mean length of hospital stay (10 days) is similar to the data reported by other authors [11,33], and we believe this con rms that LG implements the bene ts of MIS in GC surgery.…”

“…Regarding the conversion to open surgery, the rates were between 0% and 12% [11,15,24,30]; we reported a rate of 5.7% (4 cases), mainly in patients with previous abdominal surgery and severe adhesions (3 cases). Approximately 25% of our patients had a history of previous abdominal surgery, and like other authors [23], we consider that this was not a contraindication for LG.…”

“…Another concern is the possible negative effects of pneumoperitoneum on cardiorespiratory function during a time-demanding surgical procedure and its in uence on the development of cardiorespiratory complications [11,15,34]. We usually maintain a 12 mm Hg pneumoperitoneum during surgery, and none of the patients in our cohort had severe cardiac or lung complications during the procedure.…”

“…The operative procedure for laparoscopic subtotal gastrectomy (LSG) with D1-D2 lymph node dissection is relatively well standardized, and its surgical and oncological results have been supported in different studies [1,12,13]. Laparoscopic total gastrectomy (LTG) is still considered a more demanding surgical procedure, especially due to extended lymphadenectomy, esophagojejunal anastomosis and its related postoperative complications [11,14]. Recent studies have shown that the minimally invasive surgical approach (MIS) to GC is feasible and safe [4,15].…”