| Background:The morbidity and mortality of gastric cancer worldwide is in the second position of malignant tumor. Gastric cancer is of the highest incidence in malignant tumor of gastrointestinal tract in Southeast Asia. China is one of the areas of high incidence of gastric cancer, the annual mortality rate of 16/10 million, high incidence of 60/10 million, In recent years, with improvement of diagnostic techniques and maturity of surgery and chemoradiation treatment strategies aiming at tumor, the overal15-year survival rate of GC has increased, but the postoperative recurrence rate is still high, and prognosis effect is not very satisfactory. Gastric cancer can be divided into simple and advanced gastric cancer. The detection rate of early gastric cancer accounts for about 5% of the domestic. More than 70% of patients were already advanced gastric cancer in treatment, and the recurrence of advanced gastric cancer after radical surgery was50%-70%.. In recent years, the incidence of gastric cancer in the elderly is increasing year by year.Because the elderly patients were accompanied by cardiovascular disease, lung disease, metabolic disorder, dysfunction and organ dysfunction. The surgical treatment of the complications caused will increase the risks with the increase of age.Objective:To investigate the risk factors for postoperative pulmonary complications (PPCs) in aged patients after gastric cancer surgery.Methods:By multiple logistic regression analysis, we retrospectively analyzed the risk factors for PPCs of 263 patients (above 65 years old) having undergone gastric cancer surgery between October 2008 and October 2013. The age related preoperative complications (i.e.hypertension, coronary artery disease, EKG change, diabetes mellitus, respiratory diseases, liver function insufficiency, liver cirrhosis, hypoalbuminemia, anaemia, electrolyte imbalance ete.) and postoperative pulmonary complications were analyzed.Results:(1) Among the 263 elderly patients undergoing gastric cancer operation,69 had postoperative pulmonary complications, with an incidence rate of 26.24%. Among these patients,33 had pulmonary infection,26 had pleural effusion,10 had pulmonary atelectasis,7 had pulmonary edema,4 had acute respiratory failure and 3 had adult respiratory distress syndrome; concurrence of various pathological patterns occurs in some of the patients. Such symptomatic treatments as assisted ventilation, cardiotonic therapy, anti-infective treatment and nutritional support were given to the 69 elderly gastric cancer patients after their occurrence of postoperative pulmonary complications, and after related treatment,66 of them were improved and discharged, while 3 of them died because of postoperative secondary multiple organ failure.(2) Among the 69 cases with pulmonary complications,46 were male patients (accounting for 24.60% of all male patients),23 were female patients (accounting for 30.26% of all female patients). Female patients had a higher incidence rate of pulmonary complications than male patients after laparotomy for gastric cancer, but there was no statistically significant difference between the two according to statistical calculation (P>0.05), indicating that there was no obvious difference in gender regarding the incidence rate of pulmonary complications after laparotomy for elderly gastric cancer patients.(3) The included elderly gastric cancer patients undergoing laparotomy had an average age of (73.6±6.2); after laparotomy, patients with pulmonary complications had an average age of (72.8±7.0) and patients without pulmonary complications had an average age of (74.2±8.5); there was no statistically significant difference between the two according to statistical calculation (P>0.05). When patients were stratified by age, patients aged from 65 to 69 had an incidence rate of postoperative pulmonary complications of 22.65%; patients aged from 70 to 74 had an incidence rate of postoperative pulmonary complications of 29.52%; patients aged from 75 to 79 had an incidence rate of postoperative pulmonary complications of 36.62% and those aged above 80 had an incidence rate of postoperative pulmonary complications of 11.21%. It can be seen from the result of the analysis that patients aged from 75 to 79 had the highest incidence rate of postoperative pulmonary complications.(4) BMI of each enrolled patient was respectively calculated according to their weight and height, taking the BMI of 24Kg/m~2 as the cut-off point. Research found that there were 85 patients with a BMI≥24Kg/m~2, among which 30 patients had pulmonary complications after laparotomy (accounting for 35.29% in this group); there were 178 patients with a BMI<24Kg/m~2, among which 39 patients had pulmonary complications after laparotomy (accounting for 21.91% in this group); as shown by statistical test, there was statistically significant difference between these two groups divided by BMI (P<0.05).(5) There were in total 102 elderly gastric cancer patients had smoking history (accounting for 38.78% of all patients), among which 34 patients had pulmonary complications (accounting for 33.33% in this group); while among those had no smoking history,35 patients had pulmonary complications (accounting for 21.74% in this group); as shown by statistical test, there was statistically significant difference between these two groups regarding the occurrence of pulmonary complications (P<0.05).(6) There were in total 119 diabetic patients, among which 40 patients had pulmonary complications after laparotomy (accounting for 33.61%), while pulmonary complications occurred in 29 patients among the 144 patients without history of diabetes (accounting for 20.14%); according to statistical analysis carried out among those had pulmonary complications in these two groups, there was statistically significant difference (P<0.05). There were in total 147 patients with hypertension, among which 42 patients had pulmonary complications after laparotomy (accounting for 28.57%), while pulmonary complications occurred in 27 patients among the 116 patients without history of hypertension (accounting for 23.28%); according to statistical analysis carried out among those had pulmonary complications in these two groups, there was no statistically significant difference (P>0.05).(7) Patients’MVV was obtained according to the lung function test before their enrollment, taking the MVV of 60% as the cut-off point. Research found that there were 112 patients with a MVV<60%, among which 44 patients had pulmonary complications after laparotomy (accounting for 39.29% in this group); there were 151 patients with a MVV>60%, among which 25 patients had pulmonary complications after laparotomy (accounting for 16.56% in this group); as shown by statistical test, there was statistically significant difference between these two groups divided by MVV (P<0.05). Patients’ FEV1% was obtained according to the lung function test before their enrollment, taking the FEV1% of 50% as the cut-off point. Research found that there were 110 patients with a FEV1%<50%, among which 37 patients had pulmonary complications after laparotomy (accounting for 33.64% in this group); there were 153 patients with a FEV1%>50%, among which 32 patients had pulmonary complications after laparotomy (accounting for 20.92% in this group); as shown by statistical test, there was statistically significant difference between these two groups divided by FEV1%(P<0.05).(8) There were in total 85 patients with hypoproteinemia, among which 32 patients had pulmonary complications after laparotomy (accounting for 37.65%), while pulmonary complications occurred in 37 patients among the 178 patients without hypoproteinemia (accounting for 20.79%); according to statistical analysis carried out among those had pulmonary complications in these two groups, there was statistically significant difference (P<0.05).(9) Color Doppler examination of the heart was performed to all the patients before operation and 139 elderly gastric cancer patients (accounting for 52.85% of all the patients) with low cardiac function (EF<50%) were found, among which 49 patients had postoperative pulmonary complications (with an incidence rate of about 35.25%); taking those with an EF≥50% as the control group, it had an incidence rate of pulmonary complications of 16.13%; there was difference in incidence rate of pulmonary complications between these two groups and the difference is statistically significant (P<0.05).(10) Retrospective analysis showed that four surgical options were mainly included:total gastrectomy was performed to 129 patients, with 38 patients had pulmonary complications after operation; proximal gastrectomy was performed to 57 patients, with 14 patients had pulmonary complications after operation; distal gastrectomy was performed to 54 patients, with 11 patients had pulmonary complications after operation; and combined splenectomy was performed to 23 patients, with 6 patients had pulmonary complications after operation. When compared with patients that had no pulmonary complications, there was no statistically significant difference according to statistical analysis (P>0.05). Taking the operation duration of 4h as the cut-off point, research found that 112 patients had an operation duration<4h, among which 18 patients had pulmonary complications after laparotomy (accounting for 16.07%in this group); 151 patients had an operation duration≥4h, among which 51 patients had pulmonary complications after laparotomy (accounting for 33.77% in this group); as shown by statistical test, there was statistically significant difference between these two groups divided by the operation duration of 4h (P<0.05). Taking the blood loss of 400ml as the cut-off point, research found that 170 patients had a blood loss<400ml, among which 34 patients had pulmonary complications after laparotomy (accounting for 20% in this group); 93 patients had a blood loss≥400ml, among which 35 patients had pulmonary complications after laparotomy (accounting for 37.63% in this group); as shown by statistical test, there was statistically significant difference between these two groups divided by the blood loss of 400ml (P<0.05).(11) There were in total 62 patients complicated with other complications after operation, of which 20 patients had pulmonary complications (accounting for 32.26%); however, pulmonary complications occurred in 49 patients among the 201 patients that had no other complications after operation(accounting for 24.38%). Statistical analysis carried out among patients in these two groups showed that there was no significant difference in incidence of other postoperative complications and pulmonary complications (P>0.05).(12) Single factor analysis showed that there was obvious difference (P<0.05) between patients with pulmonary complications and those without postoperative pulmonary complications in long smoking history, body mass index (BMI≥24Kg/m~2), history of diabetes, hypoproteinemia, maximum ventilatory volume (MW<60%), the percentage of forced expiratory volume in one second to forced vital capacity (FEV1%<50%), ejection fractions (EF<50%), blood loss during operation (≥400ml) and operation duration (≥4h), and the difference is statistically significant; while there was no obvious difference in gender, hypertension, TNM stage, lymphatic metastasis, surgical option, incidence of other postoperative complications and pulmonary complications (P>0.05).Conclusion:PPCs as a common complication after gastric cancer surgery is associated with high mortality rates. Our data indicate that smoking, BMI≥25Kg/m~2, diabetes, hypoproteinemia, MVV, FEV1%, blood loss and operative time are the high priority intervention for the aged patients after gastric cancer surgery. In order to decrease the risk factors leading to postoperative pulmonary complications for elderly patients with esophageal carcinoma, it was necessary to quit smoking, completely evaluate the functions of lung, conduct effective breathing exercises, and better control the existing basic diseases before operation, and perform the minimally invasive operation, shorten operation duration. |
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