Prediction of Prolonged Postoperative Ileus After Radical Gastrectomy for Gastric Cancer

Huang, Dongdong; Zhuang, Cheng‐Le; Wang, Su‐Lin; Pang, Wenyang; Lou, Neng; Zhou, Chong‐Jun; Chen, Fan‐Feng; Shen, Xian; Yu, Zhen

doi:10.1097/md.0000000000002242

Cited by 28 publications

(43 citation statements)

References 40 publications

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“…There is no universally accepted clinical definition for POI, and PPOI is considered to be a more clinically problematic and pathologically significant entity [8]. In our study, there were no significant differences in the incidence of PPOI in the two groups.…”

Section: Discussioncontrasting

confidence: 39%

“…In the IVPCA group, the patients received a basal infusion of 1 ml/h with boluses of 1 ml and a lockout interval of 15 minutes using a pump (Autoselector; Ace Medical Co., Ltd., Korea) containing 100 ml of a solution containing fen- [7]. Prolonged postoperative ileus (PPOI) was defined as a situation wherein two or more of the following was present: nausea, inability to tolerate oral diet over 24 hours, absence of flatus over 24 hours, abdominal distension, and radiological confirmation on or after the fourth POD without prior resolution of postoperative ileus (POI) [8]. Delirium was assessed using medical records.…”

Section: Methodsmentioning

confidence: 99%

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The effects of epidural versus intravenous patient-controlled analgesia on postoperative outcomes in elderly patients who have undergone gastrectomy: a retrospective trial

Kim¹,

Lee²,

Kang³

et al. 2017

Anesth Pain Med

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Background: Efforts for improving surgical outcomes in elderly patients should include the prevention of perioperative complications and proper postoperative pain management. Epidural analgesia is effective in decreasing perioperative stress and postoperative complications, and in improving recovery. Recently, it has been suggested that epidural analgesia may attenuate immune suppression during the perioperative period and lead to reductions in cancer recurrence and improvements in overall survival. Assuming that these effects of epidural analgesia are present in vulnerable elderly patients, we compared the efficacy of epidural patient-controlled analgesia and intravenous patientcontrolled analgesia on postoperative outcomes in elderly patients who had undergone gastrectomy. Methods:We evaluated 214 elderly patients who had undergone elective open gastrectomy for gastric cancer from 2011 to 2014. The demographic characteristics, analgesic efficacy, complications within the first 30 postoperative days, hospital stay, 24-month postoperative morbidity, cancer recurrence, and mortality were studied retrospectively.Results: Two-hundred and five patients were analyzed. Eighty-five patients received epidural patient-controlled analgesia (EPCA group) and 120 patients received intravenous patient-controlled analgesia (IVPCA group). The maximum pain scores were decreased to a greater extent in the EPCA group on the day of the operation (P < 0.001) and on the first postoperative day (P = 0.001) when compared to the IVPCA group. The patients in the EPCA group also required less analgesics on the day of the operation (P = 0.033) than those in the IVPCA group. The effect of EPCA on complications within the first 30 postoperative days, 24-month postoperative morbidity, cancer recurrence, and mortality were negligible in our study.Conclusions: EPCA provided more effective pain control than IVPCA in elderly patients who had undergone elective gastric cancer surgery, but did not affect postoperative outcomes.

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Section: Discussioncontrasting

confidence: 39%

Section: Methodsmentioning

confidence: 99%

The effects of epidural versus intravenous patient-controlled analgesia on postoperative outcomes in elderly patients who have undergone gastrectomy: a retrospective trial

Kim¹,

Lee²,

Kang³

et al. 2017

Anesth Pain Med

View full text Add to dashboard Cite

show abstract

“…A large‐scale observational study of patients who underwent colorectal cancer surgeries (n = 2400) showed an insignificant association between age and mechanical bowel obstruction but did not cite the need of surgery for mechanical bowel obstruction . However, in other studies, age was an independent risk factor for mechanical bowel obstruction and was included in the predictive scoring system . It may also be that intestinal movement is slower in elderly than in younger patients, such that the elderly are more likely to develop severe mechanical bowel obstruction.…”

Section: Discussionmentioning

confidence: 99%

“…Neither of them nor the current study demonstrated a significant association. The role of previous abdominal surgery in major abdominal surgeries was controversial: the association was significant in patients with laparoscopic colectomy but not in those with gastrectomy or colorectal resection …”

Section: Discussionmentioning

confidence: 99%

Postoperative mechanical bowel obstruction after pharyngolaryngectomy for hypopharyngeal cancer: Retrospective analysis using a Japanese inpatient database

et al. 2018

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“…The incidence of PPOI was reported to vary from 3% to 32%, and there were some differences among the sites of abdominal surgery . However, a majority of the previous studies on PPOI were based on patients referred to colonic or rectal resection, and little data existed on gastrectomy …”

Section: Introductionmentioning

confidence: 99%

Prolonged postoperative ileus in gastric surgery: Is there any difference between laparoscopic and open surgery?

Liang

Zhang

et al. 2019

Cancer Medicine

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Background Prolonged postoperative ileus (PPOI) is a common complication after abdominal surgery, but data about risk factors of PPOI for patients with gastric cancer are rare. We sought to investigate the impact of laparoscopic versus open surgery for PPOI after gastric cancer surgery. Methods A retrospective cohort study was conducted using a registry database consecutively collected from June 2016 to March 2017. PPOI was defined as no bowel function persisting for more than 4 days. Univariate analysis and multiple logistic regression models were performed to investigate risk factors, and stratified analysis was carried out to examine the primary association at different levels of a potential confounding factor. Results A total of 162 patients composed of 63 patients undergoing laparotomy and 99 patients undergoing laparoscopy were enrolled and PPOI was observed in 32 (19.75%) patients. Risk factors significantly correlated with PPOI were as follows: open surgery, older age, late surgical pathologic staging, postoperative use of opioid analgesic, low level of postoperative albumin and serum potassium. Compared to open surgery, the laparoscopic surgery was a strong protective factor for PPOI after adjusting related variables (OR = 0.17, CI: 0.05‐0.52, P = .002). There was an interaction between surgical methods and the postoperative WBC level (P for interaction = .007). In the two group stratified analysis of WBC, laparoscopic surgery had a significant lower risk of PPOI than open group for the patients with WBC counts above the middle level in crude or adjusted models. This result remained significantly in the three group stratified analysis for the patients with WBC counts in the middle and or high tertile groups. Conclusions PPOI is a common postoperative complication of patients after gastrectomy. Laparoscopic surgery is associated with decreased risk of PPOI in gastric surgery. Patients who underwent open surgery and presented with high level of WBC should be cautious with PPOI.

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Prediction of Prolonged Postoperative Ileus After Radical Gastrectomy for Gastric Cancer

Abstract: Supplemental Digital Content is available in the text

Cited by 28 publications

References 40 publications

The effects of epidural versus intravenous patient-controlled analgesia on postoperative outcomes in elderly patients who have undergone gastrectomy: a retrospective trial

The effects of epidural versus intravenous patient-controlled analgesia on postoperative outcomes in elderly patients who have undergone gastrectomy: a retrospective trial

Postoperative mechanical bowel obstruction after pharyngolaryngectomy for hypopharyngeal cancer: Retrospective analysis using a Japanese inpatient database

Prolonged postoperative ileus in gastric surgery: Is there any difference between laparoscopic and open surgery?

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