Risk Factors in Relation to Postoperative Complications in Patients Undergoing Esophagectomy or Gastrectomy for Cancer

Abstract

To clarify the risk factors contributing to postoperative complications in the elderly patients (over 70 years) undergoing esophagectomy and/or gastrectomy, 364 patients with primary cancer seen were evaluated. As a result, some characteristic patterns of stress response in the elderly could be detected as follows: the disorders of the vital organs were more important indices for the development of postoperative complications rather than age, and a reduction in the maximum response of the stress hormones to surgical procedures in aged patients was noted; moreover, the functional variability of target organ in the aged group was confirmed. Studies on the hormonal response to surgery suggest that the restriction of fluid replacement is advisable until the third postoperative day, maintaining the host on the dry side, to prevent cardiopulmonary complications. As the nutritional status in the patients with esophageal and gastric cancer goes from bad to worse with the advancing clinical stages, adequate perioperative nutrition is imperative to prevent complications such as anastomotic leakage, wound dehiscence, and/or infections. For the treatment of anastomotic leaks after esophagectomy and esophagogastrectomy, more than 45 kcal/kg/d must be provided, and the serum albumin level must be restored to 3.5 g/dL in order to achieve spontaneous healing of small anastomotic leakages.

Preoperative Adjuvant Radiochemotherapy May Increase the Risk in Patients Undergoing Thoracoabdominal Esophageal Resections

“…The fact that many of these patients present with a compromised health status due to impaired food intake and often abuse of tobacco and alcohol expose the clinician to a complex decision-making process. The preoperative physical fitness of the patient has in fact been identified to be of particular importance in predicting the risk of morbidity and mortality in these patients [1, 2, 3, 4, 5]. A working capacity of ≤90 W, as assessed by a bicycle exercise test, has been demonstrated to be closely related to the postoperative risk after thoracoabdominal resections [2].…”

Serum hepatocyte growth factor as an index of disease status of patients with colorectal carcinoma

“…In clinical studies, a relationship between the concentration of HGF in serum or cancer tissue and the progression of disease has been noted in patients with gastric cancer (Taniguchi et al, 1997), oesophageal cancer (Takada et al, 1995) and breast cancer (Yamashita et al, 1994;Taniguchi et al, 1995). However, there are no reports regarding the clinical relevance of HGF in patients with colorectal carcinoma.Malnutrition or immunosuppression are involved in the development of life-threatening complications in patients with malignancies (Braga et al, 1988;Nishi et al, 1988;Dannhauser et al, 1995;Triantafillidis et al, 1995;Windsor et al, 1995;Goransson et al, 1996). Patients with advanced cancer and cachexia typically demonstrate modestly increased rates of energy expenditure with concomitant diminished food intake.…”

“…Malnutrition or immunosuppression are involved in the development of life-threatening complications in patients with malignancies (Braga et al, 1988;Nishi et al, 1988;Dannhauser et al, 1995;Triantafillidis et al, 1995;Windsor et al, 1995;Goransson et al, 1996). Patients with advanced cancer and cachexia typically demonstrate modestly increased rates of energy expenditure with concomitant diminished food intake.…”

Effect of Total Parenteral Nutrition on the Postoperative Outcome in Aged Patients with Gastric Cancer

“…The indications for radical sur gery have been extended to aged, high-risk patients. Therefore, the associated disease, vital organ function, and nutritional status of the aged patient should be evalu ated and judged as important risk factors [15], The results of this study seem to suggest that the associated diseases and vital organ function of aged patients did not signifi cantly alter their postoperative course and outcome. On the other hand, aged patients with gastric cancer are fre quently malnourished.…”

“…On the other hand, aged patients with gastric cancer are fre quently malnourished. The impact of malnutrition upon their perioperative course was usually analyzed retrospec tively [10,15]. While malnourished gastric cancer pa tients are at higher risk of complications and even death after surgical procedures [10], the prospective control study of the effect of nutritional support such as TPN on the postoperative outcome of aged patients has rarely been evaluated.…”