Influence of age on postoperative complications especially pneumonia after gastrectomy for gastric cancer

Abstract

Background The aim of this study was to investigate the influence of patients’ age on postoperative morbidities including pneumonia. Methods We reviewed the clinical records of 211 patients with stages I – III gastric cancer undergoing curative distal gastrectomy (DG) or total gastrectomy (TG). Patients were classified into an elderly (≧80 y.o.) or a control (< 80 y.o.) group. We compared patient characteristics (sex ratio, disease stage, degree of lymph node dissection, number of retrieved lymph nodes, and type of reconstruction) and early postoperative outcomes (operation time, intra-operative blood loss, and postoperative morbidity including pneumonia, and mortality) between the two groups separately in DG and TG. Results There were 134 and 77 patients who underwent DG and TG, respectively. The numbers of patients in the elderly and control groups were 25 and 109 in DG and 12 and 65 in TG. The percentage of female patients in the elderly group was greater than that in the control group in both DG and TG. The extent of lymph node dissection did not differ between two groups in TG; in contrast in DG, the rate of a D1 dissection was greater in the elderly group than in the control group. There were no differences between the two groups in distribution of disease stage, number of retrieved lymph nodes, operation time, and blood loss in DG and in TG. Overall postoperative morbidity did not differ between two groups after DG and after TG. The rate of infectious complications in the elderly group was not different from that in the control group after DG and after TG. The incidence of pneumonia was more frequent in the elderly group compared to the control group after DG (8% vs. 1%, P < 0.05) but not after TG (17% vs. 5%). When patients were compared between the elderly and the control groups regardless of type of gastrectomy, the incidence of pneumonia in the elderly group (4/37 (11%)) was greater than that in the control group (4/174 (2%), P < 0.05). Conclusions These results suggest that pneumonia is increased in patients older than 80 years after DG.

Preoperative Neutrophil‐to‐Lymphocyte Ratio may Predict Postoperative Pneumonia in Stage I–III Gastric Cancer Patients After Curative Gastrectomy: A Retrospective Study

“…Our results were comparable to the results of previous studies regarding the incidence of any postoperative complication and the incidence of pneumonia, at 33.7% and 4.7%, respectively. Some studies indicated a relationship between postoperative pneumonia and poor prognosis of GC patients, and suggested several patient or operation-related risk factors for postoperative pneumonia, such as age, smoking history, pulmonary comorbidities, operative time, and operative procedures in GC surgery [29][30][31][32]. Even though there was no signi cant difference between postoperative pneumonia and age, smoking history, pulmonary comorbidities, or operative time in this study, our results con rmed that total gastrectomy was an independent predictor of postoperative pneumonia in stage I-III GC patients after curative gastrectomy, as previous studies demonstrated.…”

Risk factors for postoperative pneumonia after laparoscopic gastrectomy in patients aged 75 years and over with gastric cancer

“…On the other hand, the older patients with D2 lymphadenectomy had 12‐fold higher risk for postoperative pneumonia compared with those with D1 or D1+ lymphadenectomy. Shibata et al 26 reported that the increased incidence of pneumonia in elderly patients is likely to be enhanced compared to younger patients (< 80 years) because of generally low incidence of pneumonia and various age‐related aggravating factors (swallowing, immune regulation, and lower esophageal sphincter dysfunctions). Therefore, there is a possibility that disruption of the plexus of sympathetic nerves surrounding the celiac, common hepatic and splenic arteries by D2 lymphadenectomy causes slow esophageal reflex, which has the potential to postoperative pneumonia in addition to poor swallowing function due to aging although it is difficult to explain the mechanism, which clearly induce postoperative pneumonia in elderly patients after D2 lymphadenectomy.…”

Mortality calculator as a possible prognostic predictor for overall survival after gastrectomy in elderly patients with gastric cancer

“…In our study, NLR and NRCmortality were found to be independent predictors of OS in addition to surgical procedure. Concerning surgical procedure, total gastrectomy sometimes results in malnutrition [19] and also cause aspiration pneumonia especially [20] in elderly patients. Given these insights, it may be better to avoid total gastrectomy for elderGC.…”