The Related Factors Of Postoperative Severe Complications In Elderly Patients With Gastric Cancer

Human gastric cancer is one of the most common malignant tumor. In China, the incidence of gastric cancer after the age of 40 gradually increased, 65-75 years old reached the peak, and the aging phenomenon in our country is becoming increasingly serious, growing number of elderly patients with gastric cancer need to be treated. To gastric cancer, surgical treatment is still the most important method. Owing to improving of technologic in perioperative management and raising the level of anesthesia, the surgical indications in elderly gastric cancer continues broadening, more and more elderly patients with gastric cancer accept surgery. There is often accompanied by elderly patients with cardiovascular disease, lung disease, combined with metabolic disorders and organ dysfunction. Furthermore,to patients,operation itself is a process of strikings, may leading to postoperative complications, and even death, so operation is a risk treament. In order to treat patients appropriatly, surgeons must assesse the risk of operation, therefore, a number of score system have been built. (Physiological and Operative Severity Score for the enUmeration of Mortality and morbidity, POSSUM) POSSUM score is one of them. POSSUM scoring system was set up by Copeland, etc.The scoring system predicting complications and death in patients with operation, was composed by 12 pre-operative independence physiological prognostic factors. According to the degree of factors ,the factors were sub-divided into 1,2,4,8 scores and 8 score for the most serious. In order to forecast accuratly, POSSUM adds to six surgical factors elected from 44 factors, forward-looking 6 months after the trial, the author confirmed that the results coming out from the scoring system for general operation are accurate. After 20 years of clinical application, many scholars have pointed out that the clinical factors of POSSUM score system have many shortcomings and limitations. It is difficult to preoperative evaluate the risk of elderly patients with gastric cancer effectively and directly in specific medical conditions.Purpose: In our study, the clinical datas of elderly patients in our hospital with gastric cancer were retrospectively investigated to analyze the major risk factors affecting post-operative complications, on the basis of POSSUM scoring system, making the scoring system evaluate postoperative complications of gastric cancer in elderly conveniencely, accurately and reasonably.Methods: 202 cases of elderly patients with gastric cancer for surgical treatment from January 2003 to December 2008 in our hospital were analyzed. By reviewing case records gender, age, preoperative data including systolic blood pressure, heart rate, leukocyte count, hemoglobin, sodium, potassium, glucose, urea nitrogen, serum albumin, prothrombin time, ECG report, chest X-ray report, Child-Pugh score, preoperative comorbidity, preoperative blood transfusion; intraoperative data including tumor location, tumor size, depth of invasion, histopathological type, the scope of lymph node metastasis, the scope of lymph node dissection, operation mode, blood loss, day surgery blood transfusion, operating time, the data of postoperative first day, including systolic blood pressure, heart rate, leukocyte count, hemoglobin, sodium, potassium, glucose, urea nitrogen. These clinical data, through statistical analysis, filter out the relevant factors. According to Ruijin Hospital classification standards for post-operative complications, the serious complication in the standard is defined to the serious complication in our study. On the basis of postoperative complications and serious degree of post-operative complications, the patients are divided into two groups, with no-severe complications group and severe complications group. The measurement data use the t test, the counting data use the chi-square test and Fisher's test. Application of statistical software version SPSS13.0 statistical analysis of data, P <0.05 for the difference has statistical significance.Results: The occurrence of complications in the patients: Among 202 cases of selected patients, there are 53 cases suffered from post-operative complications, the postoperative complication rate is 26.2%, of which minor complications in 26 cases, moderate complications in 12 cases, severe complications in 15 cases, 49%, 22.6%, 28.4%, respectively. Two severe complications were in six patients. Furthermore multiple complications, pancreatic fistula, anastomotic leakage, heart failure and respiratory failure, were in one patient.Using t tests, chi-square test and Fisher's test analyze measurement data and counting data respectively. The time of D2 and D3 resecton are 227.41±40.21 minutes and 283.75±34.73 minutes, P=0.009. The results suggest that between no-severe complications group and severe complications group,preoperative serum albumin, preoperative comorbidity, total gastrectomy, combined organ resection, blood loss(800ml), day surgery blood transfusion, blood glucose of the postoperative first day was statistically significant difference.Conclusion: 1. Preoperative serum albumin, preoperative comorbidity associates with serious complications after operation in elderly patients with gastric cancer. 2. Total gastrectomy, combined organ resection, associates with serious complications after operation in elderly patients with gastric cancer. 3. Blood loss, day surgery blood transfusion associates with serious complications after operation in elderly patients with gastric cancer. 4. Blood glucose of the postoperative first day associates with serious complications after operation in elderly patients with gastric cancer.