Risk Factors for Operative Complications in Elderly Patients During Laparoscopy-Assisted Gastrectomy

Hwang, Sun-Hwi; Park, Do Joong; Jee, Ye Seob; Kim, Hyung‐Ho; Lee, Hyuk-Joon; Yang, Han‐Kwang; Lee, Kuhn Uk

doi:10.1016/j.jamcollsurg.2008.10.023

Cited by 72 publications

(61 citation statements)

References 25 publications

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“…The incidence of complications classified as grade III or above in the Clavien-Dindo grading system was approximately 10 % in our cohort. This rate was relatively low and satisfactory compared with previous studies [18,19,21], especially considering that we performed radical surgery involving modified D2 lymph node dissection with curative intent. Median postoperative hospital stay (range) was 11 (7-55) days, which did not seem to be different from previously reported postoperative stay after LADG in all age groups, although statistical analysis was not performed [33].…”

Section: Discussionsupporting

confidence: 60%

“…Several previous studies indicating the feasibility of LAG in the elderly concluded that LAG produces an incidence rate of postoperative complications in the elderly similar to that in younger patients [18][19][20][21]. However, the definition of complication severities after LAG in the elderly was not strictly defined in these previous reports.…”

Section: Discussionmentioning

confidence: 96%

“…Although several studies found no significant difference in the incidence of postoperative complications between elderly and younger patients undergoing LAG [18][19][20][21], severity of complications was poorly defined in most of these studies.…”

Section: Introductionmentioning

confidence: 96%

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Potentially fatal complications for elderly patients after laparoscopy-assisted distal gastrectomy

et al. 2013

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Background The safety of surgery for gastric cancer in the elderly has been shown previously. However, potentially fatal complications based on an established severity grading system were not well described, and associated risk factors have not been assessed. The present study sought to examine severity-dependent postoperative complications after laparoscopy-assisted distal gastrectomy (LADG) in elderly patients and risk factors of potentially fatal postoperative complications. Methods The study included 189 patients aged 70 years or older and who underwent LADG for early gastric cancer. Patient characteristics, perioperative outcomes, postoperative complications including severity assessment using the Clavien-Dindo classification, and risk factors related to postoperative complications were analyzed. Results The overall complication rate was 24.9 % (47/189). The most frequent complication was abdominal fluid collection (9 cases, 4.8 %). Severe complications classified as grade III or above in the Clavien-Dindo grading system were found in 20 (10.6 %) patients. Multivariate analysis identified preoperative serum albumin concentration (odds ratio, 5.200; 95 % CI, 1.706-15.850), Roux-en-Y reconstruction (odds ratio, 3.611; 95 % CI, 1.103-11.817), and simultaneous cholecystectomy (odds ratio, 5.008; 95 % CI, 1.378-18.201) as independent predictors of a higher rate of severe postoperative complications after LADG in elderly patients. Conclusion The incidence of severe complications after LADG in the elderly was quite acceptable considering the risks associated with radical surgery with extensive lymphadenectomy. Preoperative serum concentrations of albumin (\4.0 g/dl), Roux-en-Y reconstruction, and simultaneous cholecystectomy are independent risk factors for severe postoperative complications in these patients.

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Section: Discussionsupporting

confidence: 60%

Section: Discussionmentioning

confidence: 96%

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Potentially fatal complications for elderly patients after laparoscopy-assisted distal gastrectomy

et al. 2013

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“…Age, sex, comorbidity, and body mass index (BMI) have been reported as risk factors associated with surgical complications after laparoscopy-assisted gastrectomy for gastric cancer in recent studies [1,5,6,7,8]. Although several studies comparing LADG with ODG in terms of short-term results have been reported from Far Eastern countries, there were few studies that compared LADG with ODG after excluding surgical risk factors which could influence the clinical outcomes [9].…”

Section: Introductionmentioning

confidence: 99%

Laparoscopy-Assisted Distal Gastrectomy Compared to Open Distal Gastrectomy in Early Gastric Cancer

Han

Lee²,

Han³

et al. 2011

Dig Surg

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Background: This study aimed to evaluate the feasibility of laparoscopy-assisted distal gastrectomy (LADG) in early gastric cancer (EGC) with special interest in a learning curve effect. Methods: The clinical outcomes of EGC patients who underwent LADG (n = 100) and sex-, age- and body mass index- (BMI) matched EGC patients who underwent open distal gastrectomy (ODG; n = 100) were compared retrospectively. In addition, the outcomes between the early (n = 50) and late LADG group (n = 50) were compared. Results: The mean number of retrieved lymph nodes was significantly smaller in the LADG group than in the ODG group (29.3 vs. 36.4, p < 0.001). The operative time of the LADG group was significantly longer than in the ODG group (249.1 vs. 152.9 min, p < 0.001). The complication rates were comparable between both groups (14 vs. 13%, p = 0.84). No cancer-related death was observed in either group. Between early and late LADG groups, the operative time was shorter (p < 0.001) and the number of retrieved lymph nodes was higher (p = 0.016) in the late group. Conclusions: LADG seems to be a safe and feasible procedure in treating EGC, as it shows comparable outcomes with ODG. The potential disadvantages of LADG, such as longer operation time and smaller number of retrieved lymph nodes, diminished after overcoming the learning curve.

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“…No meta-analyses and prospective studies have been reported, but outcomes of LAG in gastric cancer patients with comorbid and/or existing diseases have been reported in retrospective studies. Studies in elderly patients have found that complication rates were lower than those in the non-elderly patients, but the shorter surgical times and fewer lymph node dissections suggest that the number of lymph node dissections may be reduced (17,18). Indications in the elderly appear to be favourable in terms of post-operative ambulation considering factors such as the degree of dissection in accordance with the status of the patient.…”

Section: Evidence Regarding Indications For Laparoscopic Surgery In Gmentioning

confidence: 99%

Minimally invasive surgery for stomach cancer

Nunobe

Kumagai

Ida

et al. 2016

Jpn. J. Clin. Oncol.

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Laparoscopic surgery for gastric cancer has become extremely widespread in recent years especially in Asian countries due to its low invasiveness. As to evidence of indication for laparoscopic surgery for gastric cancer, laparoscopic surgery for gastric cancer often appears to be indicated for early gastric cancer at many institutions, while evidence was considered to be insufficient to recommend laparoscopic surgery for gastric cancer at Stage II and above. There are also problems with indications for cases other than tumour factors. No meta-analyses and prospective studies have been reported, but outcomes of laparoscopic surgery for gastric cancer in gastric cancer patients with co-morbid and/or existing diseases have been reported in retrospective studies. Indications in the elderly appear to be favourable in terms of post-operative ambulation considering factors such as the degree of dissection in accordance with the status of the patient. Meta-analyses, randomized controlled trials and several retrospective studies have compared the short-term usefulness of laparoscopic surgery for gastric cancer with that of conventional gastrectomy. The superiority of laparoscopic surgery for gastric cancer has been reported in terms of the reduced amount of bleeding, a reduction in the administration frequency and period of analgesic doses, a reduction in the duration of fever, early recovery of intestinal movement and early return to oral intake. A small-scale randomized controlled trial and several retrospective studies have demonstrated no significant differences in survival rate, recurrence rate and type of recurrence between laparoscopic surgery for gastric cancer and conventional gastrectomy. The results of the aforementioned trials in early gastric cancer in Japan and Korea for which enrolment is complete remain to be published.

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Risk Factors for Operative Complications in Elderly Patients During Laparoscopy-Assisted Gastrectomy

Cited by 72 publications

References 25 publications

Potentially fatal complications for elderly patients after laparoscopy-assisted distal gastrectomy

Potentially fatal complications for elderly patients after laparoscopy-assisted distal gastrectomy

Laparoscopy-Assisted Distal Gastrectomy Compared to Open Distal Gastrectomy in Early Gastric Cancer

Minimally invasive surgery for stomach cancer

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