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Potentially fatal complications for elderly patients after laparoscopy-assisted distal gastrectomy

Gastric Cancer, 2014, Vol.17(3), pp.548-555 [Peer Reviewed Journal]

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  • Title:
    Potentially fatal complications for elderly patients after laparoscopy-assisted distal gastrectomy
  • Author: Kumagai, Koshi ; Hiki, Naoki ; Nunobe, Souya ; Jiang, Xiaohua ; Kubota, Takeshi ; Aikou, Susumu ; Tanimura, Shinya ; Sano, Takeshi ; Yamaguchi, Toshiharu
  • Found In: Gastric Cancer, 2014, Vol.17(3), pp.548-555 [Peer Reviewed Journal]
  • Subjects: Laparoscopic surgery ; Gastrectomy ; Elderly ; Postoperative complication ; Risk factor
  • Language: English
  • Description: Byline: Koshi Kumagai (1), Naoki Hiki (1), Souya Nunobe (1), Xiaohua Jiang (1,2), Takeshi Kubota (1), Susumu Aikou (1), Shinya Tanimura (1), Takeshi Sano (1), Toshiharu Yamaguchi (1) Keywords: Laparoscopic surgery; Gastrectomy; Elderly; Postoperative complication; Risk factor Abstract: Background The safety of surgery for gastric cancer in the elderly has been shown previously. However, potentially fatal complications based on an established severity grading system were not well described, and associated risk factors have not been assessed. The present study sought to examine severity-dependent postoperative complications after laparoscopy-assisted distal gastrectomy (LADG) in elderly patients and risk factors of potentially fatal postoperative complications. Methods The study included 189 patients aged 70 years or older and who underwent LADG for early gastric cancer. Patient characteristics, perioperative outcomes, postoperative complications including severity assessment using the Clavien--Dindo classification, and risk factors related to postoperative complications were analyzed. Results The overall complication rate was 24.9 % (47/189). The most frequent complication was abdominal fluid collection (9 cases, 4.8 %). Severe complications classified as grade III or above in the Clavien--Dindo grading system were found in 20 (10.6 %) patients. Multivariate analysis identified preoperative serum albumin concentration (odds ratio, 5.200 95 % CI, 1.706--15.850), Roux-en-Y reconstruction (odds ratio, 3.611 95 % CI, 1.103--11.817), and simultaneous cholecystectomy (odds ratio, 5.008 95 % CI, 1.378--18.201) as independent predictors of a higher rate of severe postoperative complications after LADG in elderly patients. Conclusion The incidence of severe complications after LADG in the elderly was quite acceptable considering the risks associated with radical surgery with extensive lymphadenectomy. Preoperative serum concentrations of albumin (<4.0 g/dl), Roux-en-Y reconstruction, and simultaneous cholecystectomy are independent risk factors for severe postoperative complications in these patients. Author Affiliation: (1) Department of Gastroenterological Surgery, Cancer Institute Hospital, Japanese Foundation for Cancer Research, 3-8-31 Ariake, Koto-ku, Tokyo, 135-8550, Japan (2) Department of General Surgery, Zhongda Hospital, Southeast University, Nanjing, China Article History: Registration Date: 06/08/2013 Received Date: 04/06/2013 Accepted Date: 04/08/2013 Online Date: 31/08/2013 Article note: This paper is not based on a previous communication to a society or meeting.
  • Identifier: ISSN: 1436-3291 ; E-ISSN: 1436-3305 ; DOI: 10.1007/s10120-013-0292-4

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