Abstract
With the extension of life expectancy, cancer has been increasing in elderly populations. Postoperative pneumonia can negatively influence immediate mortality following gastrectomy for elderly patients, but its impact on long‐term survival remains unclear. We retrospectively reviewed the cases of patients aged ≥75 years who underwent curative gastrectomy for gastric cancer from 2000 to 2014 to determine the long‐term effects of postoperative pneumonia and to identify independent risk factors along with physical status and surgical procedure. Of 250 patients, 32 (12.8%) developed postoperative pneumonia. Patients with postoperative pneumonia had significantly worse overall survival (OS) than those without postoperative pneumonia (P<.001). A multivariate analysis identified postoperative pneumonia as a prognostic factor for OS (hazard ratio, 2.06; 95% CI, 1.05‐3.75; P=.036). Significant risk factors for the development of postoperative pneumonia were male gender (P=.026) and D2 lymphadenectomy (P<.001). D2 lymphadenectomy was associated with poorer OS than D1 or D1+lymphadenectomy in patients with an American Society of Anesthesiologists (ASA) score 3 (P=.026), but did not influence OS negatively in patients with an ASA score ≤2. Limited lymphadenectomy did not affect the cancer‐specific survival of elderly patients with ASA score 3. Postoperative pneumonia following gastrectomy has an adverse impact on the long‐term survival of elderly gastric cancer patients. A limited lymphadenectomy during curative resection should be considered to prevent postoperative pneumonia in frail elderly patients with ASA score 3. Postoperative pneumonia following gastrectomy has an adverse impact on the long‐term survival of elderly gastric cancer patients. Extent of lymph node dissection during curative resection should be limited to prevent postoperative pneumonia, based on the patient's frailty.
Highlights
Clinical characteristics, surgical outcomes, pathological findings and follow-up data were extracted from medical records
Several studies have shown a relationship between postoperative complications and long-term survival in various malignancies.[10,12,19,20]
Infectious complications after gastrectomy caused by anastomotic leakage, procedure-related infection or any type of infection were reported to have a negative effect on survival.[21,22,23]
Summary
Surgical outcomes, pathological findings and follow-up data were extracted from medical records. PNI was calculated as 109 serum segment of the population presents a challenge, as elderly patients albumin value +0.0059 total lymphocyte count in peripheral blood usually have comorbidities and poor physical status that adversely just before resection.[15] Tumor status was diagnosed according to affect their surgical outcomes and prolong their postoperative the Japanese Gastric Cancer Association classification system.[16] disabilities.[3,4,5]. Clavien-Dindo classification.[18] Pneumonia was diagnosed based on nia may have a crucial role in the development of therapeutic stratethe findings of consolidation by chest X-ray or computed tomogragies to reduce the incidence and impact of pneumonia in elderly phy (CT), and on the clinical findings Operative pneumonia after curative gastrectomy on long-term survival in elderly gastric cancer patients and to identify potential.
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