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

Abstract

Introduction The proportion of patients aged 75 years and over who undergo minimally invasive surgery for gastric cancer is increasing. However, the safety and feasibility of laparoscopic gastrectomy (LG) in this age group is controversial. This study aimed to evaluate whether LG is safe and effective in patients aged 75 years and over. Methods The study included 728 patients with early and advanced gastric cancer who underwent curative LG between 2009 and 2017; 166 of these patients (22.8%) were aged 75 or over. All surgeries were performed laparoscopically. Selected clinical factors were compared between the 166 patients aged 75 years and over and the 562 patients aged under 75 years. Results There were significant differences in presence of comorbidity, respiratory function and American Society of Anesthesiologists physical status scores between the older and younger groups. The older patients more frequently developed complications than the younger ones, particularly postoperative pneumonia. According to multivariate analyses of all participants, age, chronic obstructive pulmonary disease (COPD), and D2 lymphadenectomy were independent risk factors for postoperative pneumonia. Advanced stage and D2 lymphadenectomy were independent risk factors in the older group, whereas only COPD was an independent risk factor in the younger group. Conclusions LG for gastric cancer can be safely performed in patients aged over 75 years with an acceptable complication rate. However, the present data suggest that care should be taken in selecting LG with D2 lymphadenectomy to treat advanced cancer in these patients because the risk of postoperative complications, especially postoperative pneumonia, increases.

The Cancer Cachexia Index Can Be Used to Prognostically Predict Patients with Gastric Cancer Undergoing Gastrectomy

“…Postoperative pneumonia was more common in low CXI patients. Reported risk factors for postoperative pneumonia after surgery for GC include advanced age, poor nutritional status, total gastrectomy, time to first meal after surgery, extended operation times, D2 lymph node dissection, advanced tumor stage, and predicted vital capacity [34][35][36][37]. It is difficult to prevent pneumonia via surgical techniques because the extent of gastrectomy and lymph node dissection is essentially predetermined by tumor location and progression.…”

Prognostic factors for elderly gastric cancer patients who underwent gastrectomy

“…As well as the extent of gastrectomy, the extent of lymphadenectomy is also recommended to be limited in patients aged ≥ 80 years [ 19 ]. A recent paper showed that D2 lymphadenectomy was an independent risk factor for postoperative pneumonia in patients aged ≥ 75 years [ 20 ]. In our study, ≥ D2 lymphadenectomy provided fair prognoses, and D1+ lymphadenectomy was also acceptable.…”

Impact of Frailty on Treatment Outcomes for Elderly Patients with Gastric Cancer Undergoing Gastrectomy: A Prospective Cohort Study

“…Postoperative pneumonia was more common in frail patients in our study. Risk factors for postoperative pneumonia after surgery for GC have been reported and include advanced age, poor nutritional status, total gastrectomy, time to rst meal after surgery, extended operation time, D2 lymph node dissection, advanced tumor stage, and predictive vital capacity (VC) [24][25][26][27] . Several large trials have shown that the incidence of postoperative pneumonia was not signi cantly different between LG and OG 21,22,28 .…”