影响老年癌症胃切除术中短期和长期疗效的预后因素

IF 1.8 3区 医学 Q3 GASTROENTEROLOGY & HEPATOLOGY Digestive Surgery Pub Date : 2022-04-19 DOI:10.1159/000524609
Nobuhiro Tsuchiya, C. Kunisaki, Hiroki Kondo, Sho Sato, Kei Sato, J. Watanabe, K. Takeda, T. Kosaka, H. Akiyama, I. Endo
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引用次数: 4

摘要

引言:手术对老年癌症患者的益处是有争议的。这项在日本进行的单机构回顾性研究旨在评估胃切除术对老年癌症患者的影响。方法:2002年4月至2018年12月,234名年龄≥80岁的组织学确诊的癌症患者在横滨市立大学医学中心消化道中心接受了手术治疗。失访(n=27)、肿瘤不符合手术条件(n=14)和无法实现R0切除(n=7)的患者被排除在本回顾性研究之外。其余186名患者包括在内。评估患者特征、术中结果、术后并发症和长期生存率。结果:61例患者(32.8%)出现Clavien-Dindo≥II级的术后并发症,5年无复发生存率和总生存率分别为84.2%和63.4%。多因素分析显示,老年营养风险指数(2.36)(比值比,1.94;95%置信区间,1.02–3.67;p=0.043)和全胃切除术(TG)(比值率,1.97;p=0.042)可显著预测术后并发症。此外,TG(危险比1.91;p=0.036)是OS的独立预后因素。结论:不良的免疫营养状况和TG导致更差的短期结果。此外,TG是老年癌症患者OS的独立预后因素。有必要提供有效的围手术期护理,包括营养支持,以明确短期结果是否会得到改善。
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Prognostic Factors Affecting Short- and Long-Term Outcomes of Gastrectomy for Gastric Cancer in Older Patients
Introduction: The benefits of surgery in older patients with gastric cancer are controversial. This single-institution retrospective study in Japan aimed to evaluate the impact of gastrectomy in older patients with gastric cancer. Methods: A series of 234 patients aged ≥80 years with histologically confirmed gastric cancer had indications for surgical treatment at the Gastroenterological Center, Yokohama City University Medical Center, between April 2002 and December 2018. Patients who were lost to follow-up (n = 27), had tumors not eligible for surgery (n = 14), and could not achieve R0 resection (n = 7) were excluded from this retrospective study. The remaining 186 patients were included. Patient characteristics, intraoperative outcomes, postoperative complications, and long-term survival were evaluated. Results: The incidence of postoperative complications with Clavien–Dindo grade ≥ II was observed in 61 patients (32.8%). The 5-year relapse-free survival and overall survival (OS) rates were 84.2% and 63.4%, respectively. Multivariate analysis showed that geriatric nutritional risk index (<98) (odds ratio, 1.97; p = 0.047), neutrophil/lymphocyte ratio (>2.36) (odds ratio, 1.94; 95% confidence interval, 1.02–3.67; p = 0.043), and total gastrectomy (TG) (odds ratio, 1.97; p = 0.042) significantly predicted postoperative complications. Moreover, TG (hazard ratio, 1.91; p = 0.036) was an independent prognostic factor of OS. Conclusions: Poor immunonutritional status and TG led to worse short-term outcomes. Moreover, TG was an independent prognostic factor of OS in older patients with gastric cancer. It is necessary to provide effective perioperative care, including nutritional support, to clarify whether short-term outcomes would be improved.
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来源期刊
Digestive Surgery
Digestive Surgery 医学-外科
CiteScore
4.90
自引率
3.70%
发文量
25
审稿时长
3 months
期刊介绍: ''Digestive Surgery'' presents a comprehensive overview in the field of gastrointestinal surgery. Interdisciplinary in scope, the journal keeps the specialist aware of advances in all fields that contribute to improvements in the diagnosis and treatment of gastrointestinal disease. Particular emphasis is given to articles that evaluate not only recent clinical developments, especially clinical trials and technical innovations such as new endoscopic and laparoscopic procedures, but also relevant translational research. Each contribution is carefully aligned with the need of the digestive surgeon. Thus, the journal is an important component of the continuing medical education of surgeons who want their practice to benefit from a familiarity with new knowledge in all its dimensions.
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