Evaluation of modified Estimation of Physiologic Ability and Surgical Stress in gastric carcinoma surgery

Background  

We recently modified our prediction scoring system “Estimation of Physiologic Ability and Surgical Stress” and have designated the current version mE-PASS. This scoring system has been designed to obtain predicted postoperative mortality rates before surgery and this study was performed to assess its usefulness in elective surgery for gastric carcinoma.     

老年胃癌患者术后并发症的临床分析

目的 探讨75岁以上老年胃癌患者术前合并疾病、临床病理情况以及术后并发症发生情况及其危险因素.方法 回顾性分析2009年1月至2009年12月间我院施行胃癌根治手术的337例患者,其中年龄≥75岁的患者40例,占11.87％,其余小于75岁的患者297例作为对照组,分析比较两组患者术前合并症等临床病理资料及术后并发症情...     

腹腔镜辅助远端胃癌根治术中、术后早期并发症及其原因分析

目的 探讨腹腔镜辅助远端胃癌根治术中、术后早期并发症及其原因分析.方法 回顾性分析我院63例行腹腔镜辅助远端胃癌根治术患者的临床资料,分析术中及术后早期并发症发生的原因,探讨其处理.结果 术中并发症14例,包括术中出血5例,皮下气肿3例,高碳酸血症2例,横结肠系膜损伤4例;中转开腹2例,中转率为3.17％,1例为术中血管损伤引起出血,1例为严重高碳酸血症;余均在腹腔镜下成功处理.术后早期并发症11例,包括术后腹腔内出血2例,戳孔感染2例,戳孔血肿1例,十二指肠残端瘘2例,吻合口瘘1例,吻合口狭窄1例,吻合口出血1例,淋巴漏1例.结论 了解腹腔镜辅助远端胃癌根治术并发症的原因和种类是减少术中和术后早期并发症的关键.     

进展期胃癌患者腹腔镜下全胃切除术后并发症发生的影响因素分析

目的探讨进展期胃癌患者腹腔镜辅助下行全胃切除术后并发症的发生情况及其影响因素。方法选取2007年1月至2016年12月间邹城市人民医院收治的194例行腹腔镜全胃切除术的进展期胃癌患者,观察所有患者术后并发症的发生情况,分析并发症发生的危险因素。结果33例(17.0%)患者术后出现并发症,以肺部感染为主,占36.4%(12例)。单因素分析,术前合并症、病灶直径、癌变部位、既往腹部手术史、手术时间和中转开腹是影响患者术后并发症发生的相关因素,差异均有统计学意义(均P<0.05);多因素logistic回归分析,术前合并症和手术时间是影响患者术后并发症发生的独立危险因素,差异均有统计学意义(均P<0.05)。结论进展期胃癌患者行腹腔镜下全胃切除术前,应积极治疗合并症,尽量缩短手术时间,降低术后并发症,提高手术安全性。     

Robotic gastrectomy for elderly gastric cancer patients: comparisons with robotic gastrectomy in younger patients and laparoscopic gastrectomy in the elderly

Background

Robotic surgery for gastric cancer has been adopted to overcome technical difficulties in performing laparoscopic gastrectomy. This study aimed to investigate the feasibility and safety of robotic gastrectomy in elderly gastric cancer patients.

Methods

Patients who underwent laparoscopic or robotic gastrectomy from 2003 to 2010 in a single high-volume center were included in this study. We retrospectively compared preoperative characteristics, perioperative factors, and oncological parameters among an elderly (≥70 years old) robotic gastrectomy group (n = 49), a younger (<70 years old) robotic gastrectomy group (n = 321), and an elderly laparoscopic gastrectomy group (n = 132).

Results

The elderly robotic group presented with more comorbidities than the younger robotic group. Except for number of retrieved lymph nodes (36.5 vs. 41.5; P = 0.007), short-term operative outcomes including complications and pathological parameters were comparable between the two robotic groups. The elderly robotic group showed comparable disease-specific survival to the younger robotic group although overall survival was worse. Compared to their laparoscopic counterparts, the elderly robotic group showed longer mean operation time (227 vs. 174 min). Nevertheless, the incidence and severity of postoperative complications was not different between the two elderly groups. Overall and disease-specific survival were also comparable between the elderly groups. In multivariate analysis, age and surgical approach were not risk factors for overall and major complications.

Conclusions

The outcomes of robotic gastrectomy in the elderly did not differ from those in younger robotic gastrectomy patients and were comparable to those in elderly patients who underwent laparoscopic gastrectomy. Thus, robotic gastrectomy could be a safe and feasible approach in elderly patients.

     

腹腔镜辅助胃癌D2根治术并发症的防治研究

目的探讨腹腔镜辅助胃癌D2根治术并发症的危险因素,为其防治积累经验。方法 160例患者随机分为试验组和对照组,试验组87例患者采用腹腔镜辅助胃癌D2根治术,对照组73例患者采用开腹全胃切除胃癌D2根治术,比较两组患者术后并发症,并对其危险因素进行Logistic回归分析。结果两组患者手术情况比较,试验组患者手术操作时间(121.5±63.2)min,清扫淋巴结(29±4)枚;对照组患者手术操作时间(125.2±54.5)min,清扫淋巴结(28±3)枚,两组比较差异无统计学意义(P>0.05)。试验组患者术中出血量(101.2±28.9)ml、肛门排气时间(2.9±.6)d、住院时间(7.2±5.3)d,对照组患者术中出血量(152.5±34.6)ml、肛门排气时间(4.1±1.1)d、住院时间(13.1±1.5)d,两组比较差异有统计学意义(P<0.05)。试验组患者出现并发症20例(23.0%),对照组患者出现并发症28例(38.4%),两组患者并发症发生率差异有统计学意义(P<0.05)。术后并发症多因素Logistic回归分析显示,全部患者出现术后并发症的危险因素为吸烟、饮酒、肿瘤大小和病理分型;试验组患者的危险因素为吸烟、饮酒、肿瘤大小和吻合方式。结论腹腔镜辅助胃癌D2根治术创伤小,具有明显微创优势。患者不良生活习惯、肿瘤状态和手术方式的选择对术后并发症有影响。     

Techniques and complications of laparoscopy-assisted distal gastrectomy (LADG) for gastric cancer.

AIM: Recently, LADG has become a viable alternative for the treatment of patients with early gastric cancer. Surgeons who are seeking to undertake, or currently practicing LADG, are concerned about unpredictable intraoperative events that occur during LADG. The aims of this study were to investigate intraoperative and postoperative complications in laparoscopy-assisted distal gastrectomy (LADG) with more than D1+beta lymphadenectomy for gastric cancer. MATERIALS AND METHODS: Of 219 patients who underwent laparoscopy-assisted gastrectomy for gastric cancer by a single surgeon between April 2003 and January 2006, 128 patients were enrolled in this study. The operative procedure was divided into five steps. Various intraoperative complications, such as bleeding and perigastric organ injuries, that occurred during different operative steps were investigated by reviewing videotapes. RESULTS: A total of 839 events of bleeding were encountered during the procedure with a mean of 6.6 per patient. The mean number of bleeding during each step was significantly different and more bleedings occurred during steps II and IV (P<0.0001). Sixteen cases of complications other than bleeding occurred in 15 patients (11.7%), and they were all managed properly without conversion or reoperation. Postoperative morbidity and mortality rates were 15.6 and 0.7%, respectively. CONCLUSION: LADG with more than D1+beta lymphadenectomy is a technically feasible and acceptable surgical modality for gastric cancer. Intraoperative bleeding was found to be the most common complication during LADG for gastric cancer, and more bleedings occurred during steps II and IV.     

腹腔镜辅助胃癌根治术对老年胃癌患者的临床疗效分析

  目的  比较老年胃癌患者和非老年患者接受腹腔镜辅助胃癌根治术后短期疗效、并发症发生情况及长期生存的差异。  方法  回顾性分析2009年4月至2013年10月就诊于北京大学肿瘤医院并接受腹腔镜辅助胃癌根治术219例患者的临床资料,比较老年组（≥65岁）与非老年组（ < 65岁）的手术情况、术后早期恢复情况及并发症发生率等,分析无病生存期和总生存期的差异。  结果  老年组术前ASA评分和合并症数目显著高于非老年组（P < 0.05）,两组患者在手术时间、术中出血量、中转开腹率等方面差异无统计学意义（均P > 0.05）。老年组患者手术后平均首次下地活动时间为（2.2±2.3）d,非老年组为（1.4±1.3）d,差异具有统计学意义（P < 0.05）。两组患者之间术后并发症发生率差异无统计学意义（34.8% vs. 28.5%,P > 0.05）。3年无病生存期和总生存期两组比较差异无统计学意义（P > 0.05）,但存在术后并发症的患者中,老年患者总生存率显著低于非老年患者（44.5% vs. 70.5%,P < 0.05）。  结论  腹腔镜胃癌根治术对老年患者安全可行,并且能够获得较好的长期生存,但仍需加强围手术期处理促进术后早期恢复、减少并发症发生。      

Timing of postoperative chemotherapy in patients undergoing perioperative chemotherapy and gastrectomy for gastric cancer

Background

For patients who qualify for perioperative chemotherapy and gastrectomy for gastric cancer, the optimal timing of the postoperative chemotherapy (PC) seems equivocal. The aim of this study was to evaluate the influence of timing of PC on overall survival (OS) in patients receiving perioperative chemotherapy.

Postoperative complications and open gastrectomy affect non-cancer-related death and shorten life expectancy in elderly patients with gastric cancer

Postoperative complications contribute to recurrences and poor long-term outcomes for gastric cancer patients, especially among the elderly. However, the prognostic effect of postoperative complications on non-cancer-related death in elderly patients with gastric cancer has not been reported. Two hundred and twenty elderly (> 75 years of age) patients with stage I gastric cancer were retrospectively identified from consecutive admissions between 1995 and 2020. Non-cancer-related death following gastrectomy occurred in 13.6% (30/220) of patients. Non-cancer-related death was associated with respiratory disease in 46.7% (14/30) of cases. Although there was no association with any preoperative comorbidities, postoperative complications [P < 0.001, HR 4.16 (95% CI: 1.91-9.02)] and open gastrectomy [P=0.002, HR 3.87 (95% CI: 1.54-9.66)] were independently associated with a poorer prognosis for non-cancer-related death. Poor nutritional status [P=0.028, OR 4.25 (95% CI: 1.17-15.4)] was an independent risk factor for postoperative complications. Postoperative complications shortened life expectancy from 8.8 years to 6.1 years. Specifically, postoperative complications shortened life expectancy from 6.7 years to 3.9 years in elderly patients over 80 years of age. Postoperative complications and open gastrectomy affected the incidence of non-cancer-related death among elderly patients with gastric cancer, primarily attributed to respiratory disease. Efforts should be made to perform minimally invasive surgery, improve preoperative nutrition, and avoid postoperative complications.     

老年胃癌患者术后肺部并发症危险因素分析及防治策略

目的:回顾性分析老年患者胃癌根治术后肺部并发症（postoperative pulmonary complications,PPC）的危险因素,并探讨PPC的预防与治疗措施。方法:回顾性分析2014年05月至2020年04月于我院行胃癌根治术的196例65岁以上老年患者的临床资料。统计PPC的发生情况,对可能影响PPC发生的因素进行单因素分析和多因素Logistic回归分析。结果:196例患者行胃癌根治术,有24例出现PPC,PPC的发生率为12.2%。单因素分析显示,年龄≥75岁、体质量指数（body mass index,BMI）≥28 kg/m2、长期吸烟史、合并呼吸系统疾病、开腹手术、术后胃管留置时间≥5 d与老年胃癌患者PPC的发生相关（P＜0.05）。多因素 Logistic 回归分析显示,合并呼吸系统疾病是PPC发生的独立危险因素（OR=37.291,P＜0.05）。结论:合并呼吸系统疾病是老年胃癌患者PPC发生的独立危险因素。针对罹患呼吸系统基础疾病的老年胃癌患者,应采取合理的预防及治疗措施,以期减少PPC的发生。     

70岁以上老年肺癌术后并发症分析

目的:分析70岁以上老年患者肺癌术后并发症的原因.方法:回顾性分析30例老年肺癌患者手术的临床资料.结果: 全组住院期间死亡2例,术后发生呼吸衰竭16例,心律失常8例,1年生存率为76.6%,3年生存率38.6%.结论: 生理年龄和心肺功能是影响高龄肺癌患者外科治疗的重要因素, 围术期处理是手术成功的关键.     

Results of total gastrectomy with extended lymphadenectomy for gastric cancer in elderly patients

BACKGROUND AND OBJECTIVES: The incidence of gastric cancer, in people over 70 years of age, has increased remarkably. Aggressive lymphadenectomy with gastrectomy has been reported to improve survival in patients with gastric cancer. Because complication rates following gastrectomy increase with advancing age, we sought to determine whether this procedure was merited in elderly patients with gastric cancer. METHODS: We performed a retrospective analysis of 202 patients who underwent total gastrectomy with extended lymphadenectomy for gastric carcinoma. Postoperative complication rates were compared between patients over and under 70 years of age. RESULTS: The 10-year survival rates of patients under and over 70 years of age following total gastrectomy with extended lymphadenectomy were not significantly different. Although medical comorbidities in each group were similar, pulmonary dysfunction was significantly more common following total gastrectomy in patients over 70 years than in patients under 70 years. Moreover, logistic regression analysis revealed that patient's age was the only variable that independently correlated with the presence of postoperative complications. CONCLUSIONS: The prognosis of the gastric cancer patients over 70 years of age was similar to that of younger patients after total gastrectomy with extensive lymphadenectomy. However, pulmonary dysfunction was significantly more common in patients over 70 years old.     

全腹腔镜下远端胃癌根治术治疗高龄胃癌患者的疗效观察

目的:探讨全腹腔镜下远端胃癌根治术治疗高龄胃癌患者的临床疗效。方法:选取2019年1月至2021年12月期间在我院接受腹腔镜下胃癌根治术的高龄胃癌患者（≥70岁）作为研究对象,经倾向性匹配后根据手术方式分为观察组与对照组,其中观察组接受全腹腔镜下远端胃癌根治术（40例）,对照组接受腹腔镜辅助远端胃癌根治术（80例）。比较两组患者的手术近期疗效、术后并发症、免疫功能变化、生活质量与生存情况。结果:与对照组相比,观察组患者的术后并发症发生率相近（10% vs 23%,P=0.095）,但首次下床时间、首次排气时间与术后住院时间均显著较短,差异具有统计学意义（P＜0.05）。另外,观察组患者术后1周的WBC与CRP水平明显低于对照组,而CD3+、CD4+与CD4+/CD8+水平明显高于对照组。对比两组患者术后6个月的生活质量,观察组的疼痛、便秘评分明显优于对照组,差异具有统计学意义（P＜0.05）。术后随访均未发现肿瘤局部复发病例。结论:与传统的腹腔镜辅助手术相比,全腹腔镜下远端胃癌根治术治疗高龄胃癌患者具有术后恢复快、对免疫功能影响小、并发症少、生活质量高等优点,值得进一步推广应用。     

Survival impact of postoperative body mass index in gastric cancer patients undergoing gastrectomy

BackgroundThe relationship between preoperative body mass index (BMI) and the survival of postoperative gastric cancer patients is not clear. Furthermore, the survival impact with postoperative BMI is not known, even though weight loss is inevitable after gastrectomy.MethodsPatients who underwent gastrectomy for gastric cancer between 2000 and 2008 were included in the study (n = 1909). Patients were divided into three groups based on their BMIs: low (<18.5 kg/m²), normal (18.5–24.9 kg/m²), and high BMI (≥25.0 kg/m²). Patient survival was compared according to BMI at two time points: baseline and 1 year after surgery.ResultsRegarding BMI 1 year after surgery, overall survival, disease-specific survival, and recurrence-free survival were longer in the high BMI group than the low and normal BMI groups. In a Cox proportional hazards model, adjusting for the patient's age, sex, type of surgery, tumour stage, histology, curative resection, and BMI at baseline, a high BMI 1 year after surgery was associated with lower overall mortality compared to normal BMI (hazard ratio 0.51; 95% confidence interval, 0.26–0.98). However, BMI at baseline was not an independent prognostic factor.ConclusionBMI 1 year after surgery significantly predicted the long-term survival of patients with gastric cancer compared with the preoperative BMI.     

术前血清白蛋白水平正常的老年胃癌患者术后白蛋白变化与并发症的相关性分析

目的:探讨术前血清白蛋白水平正常的老年胃癌患者术后血清白蛋白变化(ΔALB)与术后并发症之间的相关性。方法:回顾性分析2014年1月至2018年12月连云港市市立东方医院经根治性手术治疗(R0切除,D2或D2+淋巴结清扫)的老年(年龄>65岁)胃癌患者的实验室指标、术后并发症情况。采用单因素和多因素分析以鉴定预测术后并发症的临床因素。计算ΔALB,绘制受试者工作特征曲线(ROC);测量ΔALB的截止值并得出诊断精度。ΔALB定义为:(术前白蛋白水平-术后第1天白蛋白水平)/术前白蛋白水平×100%。结果:本研究共纳入符合条件患者214例,并发症发生率为25.7%。通过Logistic回归分析,ΔALB、C-反应蛋白水平[CRP(POD3)]与联合脏器切除是术前ALB水平正常患者术后短期并发症的独立危险因素。根据并发症情况,计算ΔALB、CRP(POD3)与联合脏器切除的ROC曲线下面积(AUC)分别为0.719、0.609与0.614。ΔALB的截止值为17.1%,灵敏度为0.564,特异度为0.805;以17.1%作为分界值,将患者分为低ΔALB组(152例)和高ΔALB组(6...     

加速康复外科理念在高龄患者腹腔镜胃癌手术中的应用研究

目的 探讨加速康复外科理念及措施在高龄患者腹腔镜胃癌根治手术中应用的安全性和有效性.方法 回顾性分析2015年9月至2017年3月间在深圳市龙岗中心医院收治的60例接受腹腔镜胃癌根治术的高龄患者临床资料,按围术期是否采用加速康复外科措施分为ERAS组(n=30)和对照组(n=30),ERAS组患者围术期应用加速康复外科理念和措施,对照组患者采用传统治疗措施.比较两组术前基本资料、术后首次排气时间、住院时间、住院费用、术后2周胃肠功能生存质量、手术并发症的情况.结果 ERAS组术后住院时间[(8.51±0.97)天vs.(9.43±1.55)天,P<0.05]、住院费用[(49482.07±4486.59)元vs.(51774.47±3464.14)元,P<0.05]均少于对照组,ERAS组患者肺部感染发生率明显低于对照组(6.67%vs.30.00%,P<0.01).结论 高龄患者行腹腔镜胃癌根治术围术期应用加速康复外科理念和措施是安全有效的.