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Fujihata S, Sakuramoto S, Morimoto Y, Matsui K, Nishibeppu K, Ebara G, Fujita S, Oya S, Sugita H, Lee S, Miyawaki Y, Sato H, Takiguchi S, Yamashita K. Impact of loss of skeletal muscle mass within 6-12 months after gastrectomy and S1 adjuvant chemotherapy on the survival prognosis of elderly patients with gastric cancer. Surg Today 2022; 52:1472-1483. [PMID: 35394206 DOI: 10.1007/s00595-022-02489-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2021] [Accepted: 01/16/2022] [Indexed: 10/18/2022]
Abstract
BACKGROUND AND PURPOSE We investigated the impact of postoperative changes in the psoas muscle mass index (PMI) after gastrectomy and S1 adjuvant chemotherapy (AC) on the long-term outcomes of elderly patients with gastric cancer. METHODS We reviewed the medical records of 228 patients aged over 75 years, who underwent distal, proximal, or total gastrectomy between January, 2013 and March 2017. Among these patients, 78 with pStage IIA-IIIC who survived for at least 1 year without recurrence after gastrectomy were the subjects of this analysis. RESULTS The log-rank test using the cut-off value from the rate of change in PMI from 6 to 12 months after gastrectomy (late rate of decrease) showed significantly poorer prognosis for the group above the cut-off value for both overall survival (OS) and recurrence-free survival (RFS) (RFS: PMI decrease ≥ 1.55%, p < 0.001; OS: PMI decrease ≥ 1.55%, p < 0.001). Patients with a relative dose intensity of S1 below 68.7% and a late rate of decrease in PMI above 1.55% were found to have a poor prognosis. CONCLUSION It is necessary to prevent decline in the PMI of elderly patients from 6 months after gastrectomy and to administer adjuvant chemotherapy with about two-thirds or more RDI of S1 to improve their survival prognosis.
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Affiliation(s)
- Shiro Fujihata
- Department of Gastroenterological Surgery, Saitama Medical University International Medical Center, Hidaka City, Saitama, 350-1298, Japan. shiro--
| | - Shinichi Sakuramoto
- Department of Gastroenterological Surgery, Saitama Medical University International Medical Center, Hidaka City, Saitama, 350-1298, Japan
| | - Yosuke Morimoto
- Department of Gastroenterological Surgery, Saitama Medical University International Medical Center, Hidaka City, Saitama, 350-1298, Japan
| | - Kazuaki Matsui
- Department of Gastroenterological Surgery, Saitama Medical University International Medical Center, Hidaka City, Saitama, 350-1298, Japan
| | - Keiji Nishibeppu
- Department of Gastroenterological Surgery, Saitama Medical University International Medical Center, Hidaka City, Saitama, 350-1298, Japan
| | - Gen Ebara
- Department of Gastroenterological Surgery, Saitama Medical University International Medical Center, Hidaka City, Saitama, 350-1298, Japan
| | - Shohei Fujita
- Department of Gastroenterological Surgery, Saitama Medical University International Medical Center, Hidaka City, Saitama, 350-1298, Japan
| | - Shuichiro Oya
- Department of Gastroenterological Surgery, Saitama Medical University International Medical Center, Hidaka City, Saitama, 350-1298, Japan
| | - Hirofumi Sugita
- Department of Gastroenterological Surgery, Saitama Medical University International Medical Center, Hidaka City, Saitama, 350-1298, Japan
| | - Seigi Lee
- Department of Gastroenterological Surgery, Saitama Medical University International Medical Center, Hidaka City, Saitama, 350-1298, Japan
| | - Yutaka Miyawaki
- Department of Gastroenterological Surgery, Saitama Medical University International Medical Center, Hidaka City, Saitama, 350-1298, Japan
| | - Hiroshi Sato
- Department of Gastroenterological Surgery, Saitama Medical University International Medical Center, Hidaka City, Saitama, 350-1298, Japan
| | - Shuji Takiguchi
- Department of Gastroenterological Surgery, Nagoya City University Graduate School of Medical Sciences, Mizuho-cho, 1 Kawasumi, Mizuho-ku, Nagoya, Aichi, Japan
| | - Keishi Yamashita
- Division of Advanced Surgical Oncology, Research and Development Center for New Medical Frontiers, Kitasato University School of Medicine, 1-15-1, Kitasato, Minami-ku, Sagamihara City, Kanagawa, Japan
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Nakamura N, Kaida D, Tomita Y, Miyata T, Miyashita T, Fujita H, Kinami S, Ueda N, Takamura H. Risk Factors for Overall Complications and Remote Infection After Gastrectomy in Elderly Gastric Cancer Patients. In Vivo 2021; 35:2917-2921. [PMID: 34410987 PMCID: PMC8408687 DOI: 10.21873/invivo.12582] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2021] [Revised: 05/20/2021] [Accepted: 06/08/2021] [Indexed: 12/12/2022]
Abstract
BACKGROUND/AIM A significant predictive factor for the occurrence of complications after gastrectomy in elderly gastric cancer patients is yet to be determined. We aimed to evaluate the clinical factors associated with overall complications including remote infection after gastrectomy in elderly gastric cancer patients. PATIENTS AND METHODS We retrospectively analyzed data of 101 patients aged over 80 years, who underwent curative gastrectomy. We analyzed the clinicopathological factors that were independently associated with the occurrence of overall complications or remote infection by a logistic regression model. RESULTS The overall complication rate was 24.8%. We identified pneumonia as a remote infection, and the occurrence rate of remote infections was 5.9%. On multivariate analysis, hemoglobin (<11 g/dl) and operation time (>240 min) were significantly correlated with the occurrence of overall complications. Regarding the occurrence of remote infection, performing total gastrectomy and a hemoglobin level <11 g/dl were identified as significant risk factors. CONCLUSION Preoperative anemia and intraoperative factors, including the surgical procedure, could affect the occurrence of postoperative complications in elderly patients.
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Affiliation(s)
- Naohiko Nakamura
- Department of Surgical Oncology, Kanazawa Medical University Hospital, Ishikawa, Japan
| | - Daisuke Kaida
- Department of Surgical Oncology, Kanazawa Medical University Hospital, Ishikawa, Japan
| | - Yasuto Tomita
- Department of Surgical Oncology, Kanazawa Medical University Hospital, Ishikawa, Japan
| | - Takashi Miyata
- Department of Surgical Oncology, Kanazawa Medical University Hospital, Ishikawa, Japan
| | - Tomoharu Miyashita
- Department of Surgical Oncology, Kanazawa Medical University Hospital, Ishikawa, Japan
| | - Hideto Fujita
- Department of Surgical Oncology, Kanazawa Medical University Hospital, Ishikawa, Japan
| | - Shinichi Kinami
- Department of Surgical Oncology, Kanazawa Medical University Hospital, Ishikawa, Japan
| | - Nobuhiko Ueda
- Department of Surgical Oncology, Kanazawa Medical University Hospital, Ishikawa, Japan
| | - Hiroyuki Takamura
- Department of Surgical Oncology, Kanazawa Medical University Hospital, Ishikawa, Japan
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Shannon AB, Straker RJ, Fraker DL, Roses RE, Miura JT, Karakousis GC. Ninety-day mortality after total gastrectomy for gastric cancer. Surgery 2021; 170:603-609. [PMID: 33789812 DOI: 10.1016/j.surg.2021.02.010] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2020] [Revised: 01/15/2021] [Accepted: 02/01/2021] [Indexed: 12/23/2022]
Abstract
BACKGROUND Total gastrectomy for gastric cancer is associated with significant 30-day mortality, but this endpoint may underestimate the short-term mortality of the procedure. METHODS Retrospective analysis was performed using the National Cancer Database (2004-2015). Patients who underwent total gastrectomy for stage I to III gastric adenocarcinoma were identified and divided into cohorts based on 90-day mortality. Predictors of mortality were analyzed using multivariable logistic regression, and annual trends in mortality rates were calculated by Joinpoint Regression. RESULTS Of the 5,484 patients who underwent total gastrectomy, 90-day and 30-day mortality rates were 9.1% and 4.7%, respectively. Factors associated with 90-day mortality included increasing age (odds ratio 1.0, P < .001), income below the median (odds ratio 1.2, P = .039), Charlson-Deyo score ≥2 (odds ratio 1.4, P = .039), treatment at low-volume facilities (odds ratio 1.5, P < .001), N1 (odds ratio 2.0, P < .001), N2 (odds ratio 2.0, P < .001), or N3 (odds ratio 2.7, P < .001) stage disease, having <16 lymph nodes harvested (odds ratio 1.5, P < .001), and lack of treatment with chemotherapy (3.7, P < .001). Lack of health insurance (odds ratio 4.1, P = .080), and positive microscopic margins (odds ratio 1.3, P = .080) were correlated, but not significantly associated, with 90-day mortality. The 90-day mortality rate significantly declined from 14.3% in 2004 to 7.9% in 2015 (P = .006), and the 30-day mortality rate significantly declined from 7.7% in 2004 to 4.8% in 2015 (P = .009). CONCLUSION Nearly half of the deaths within 90 days after total gastrectomy for cancer occur beyond 30 days postoperative. Ninety-day mortality has improved over time, but rates remain high, suggesting the need for improved out-of-hospital postoperative care beyond 30 days.
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Affiliation(s)
- Adrienne B Shannon
- Department of Surgery, Hospital of the University of Pennsylvania, Pennsylvania, PA
| | - Richard J Straker
- Department of Surgery, Hospital of the University of Pennsylvania, Pennsylvania, PA
| | - Douglas L Fraker
- Division of Endocrine and Oncologic Surgery, Department of Surgery, Hospital of the University of Pennsylvania, Pennsylvania, PA
| | - Robert E Roses
- Division of Endocrine and Oncologic Surgery, Department of Surgery, Hospital of the University of Pennsylvania, Pennsylvania, PA
| | - John T Miura
- Division of Endocrine and Oncologic Surgery, Department of Surgery, Hospital of the University of Pennsylvania, Pennsylvania, PA
| | - Giorgos C Karakousis
- Division of Endocrine and Oncologic Surgery, Department of Surgery, Hospital of the University of Pennsylvania, Pennsylvania, PA.
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Zhang FX, Miao Y, Ruan JG, Meng SP, Dong JD, Yin H, Huang Y, Chen FR, Wang ZC, Lai YF. Association Between Nitrite and Nitrate Intake and Risk of Gastric Cancer: A Systematic Review and Meta-Analysis. Med Sci Monit 2019; 25:1788-1799. [PMID: 30850575 PMCID: PMC6420797 DOI: 10.12659/msm.914621] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2018] [Accepted: 01/22/2019] [Indexed: 01/16/2023] Open
Abstract
BACKGROUND Studies have shown inconsistent associations of nitrite and nitrate intake with the risk of gastric cancer or its associated mortality. We performed a meta-analysis of observational studies to evaluate the correlation of nitrite and nitrate intake with the risk of gastric cancer. MATERIAL AND METHODS We searched for studies reporting effect estimates and 95% confidence intervals (CIs) of gastric cancer in PubMed, EMBASE, and the Cochrane Library through November 2018. The summary results of the included studies were pooled using a random-effects model. RESULTS Eighteen case-control and 6 prospective cohort studies recruiting 800 321 participants were included in this study. The summary results indicated that the highest (odds ratio [OR], 1.27; 95%CI, 1.03-1.55; P=0.022) or moderate (OR: 1.12; 95%CI, 1.01-1.26; P=0.037) nitrite intake were associated with a higher risk of gastric cancer. However, we noted that high (OR, 0.81; 95%CI, 0.68-0.97; P=0.021) or moderate (OR, 0.86; 95%CI, 0.75-0.99; P=0.036) nitrate intakes were associated with a reduced risk of gastric cancer. These associations differed when stratified by publication year, study design, country, the percentage of male participants, assessment of exposure, adjusted model, and study quality. CONCLUSIONS High or moderate nitrite intake was associated with higher risk of gastric cancer, whereas high or moderate nitrate intake was correlated with lower risk of gastric cancer.
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Affiliation(s)
- Fei-Xiong Zhang
- Department of Gastroenterology, General Hospital of Ningxia Medical University, Yinchuan, Ningxia, P.R. China
| | - Yu Miao
- Department of Gastroenterology, General Hospital of Ningxia Medical University, Yinchuan, Ningxia, P.R. China
| | - Ji-Gang Ruan
- Department of Gastroenterology, General Hospital of Ningxia Medical University, Yinchuan, Ningxia, P.R. China
| | - Shu-Ping Meng
- Department of Radiology, General Hospital of Ningxia Medical University, Yinchuan, Ningxia, P.R. China
| | - Jian-Da Dong
- Department of Pathology, Ningxia Medical University, Yinchuan, Ningxia, P.R. China
| | - Hua Yin
- Department of Gastroenterology, General Hospital of Ningxia Medical University, Yinchuan, Ningxia, P.R. China
| | - Ying Huang
- Department of Gastroenterology, General Hospital of Ningxia Medical University, Yinchuan, Ningxia, P.R. China
| | - Fu-Rong Chen
- Ningxia Medical University, Yinchuan, Ningxia, P.R. China
| | | | - Ya-Fang Lai
- Department of Gastroenterology, Ordos Center Hospital, Ordos, Inner Mongolia, P.R. China
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Aoyama T, Maezawa Y, Yoshikawa T, Segami K, Kano K, Hayashi T, Yamada T, Numata M, Goda M, Tamagawa H, Sato T, Yukawa N, Rino Y, Masuda M, Ogata T, Cho H, Oshima T. Comparison of Weight and Body Composition After Gastrectomy Between Elderly and Non-elderly Patients With Gastric Cancer. In Vivo 2018; 33:221-227. [PMID: 30587627 DOI: 10.21873/invivo.11463] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2018] [Revised: 11/04/2018] [Accepted: 11/07/2018] [Indexed: 01/10/2023]
Abstract
BACKGROUND Body weight, especially lean body mass, significantly decreases after gastrectomy for gastric cancer due to surgical invasion, reduced food intake, and reduced mobility, which can reduce the quality of life and induce associated toxicity or reduce compliance with adjuvant chemotherapy. Such risks can be particularly high in elderly patients with gastric cancer. However, whether or not changes in the weight and body composition differ between elderly and non-elderly patients remains unclear. PATIENTS AND METHODS This retrospective study examined patients who underwent curative surgery for gastric cancer between May 2010 and February 2017. Body weight and composition were evaluated by a bioelectrical impedance analyzer within 1 week before surgery, at 1 week after surgery, and at 1 and at 3 months after surgery. Patients were classified as elderly (≥80 years) or non-elderly (<80 years). RESULTS Eight-hundred and eighty-eight patients (84 elderly and 804 non-elderly) were entered into the present study. Patient background, surgical and clinicopathological factors, and surgical complications did not significantly differ between the two groups. Body weight loss at 1 week, and at 1 and 3 months after surgery, defined as the decrease from the preoperative value, were -2.8%, -6.5%, and -9.0%, respectively, in the elderly and -3.5%, -6.0%, and -8.1%, respectively, in the non-elderly patients (p=0.111, 0.125, and 0.153, respectively). The corresponding losses of lean body mass were -2.6%, -6.0%, and -6.4%, respectively, in the elderly and -3.5%, -4.9%, and -4.7%, respectively, in the non-elderly patients, with p-values of 0.056, 0.036, and 0.029, respectively. CONCLUSION Decreases in lean body mass after gastrectomy were greater in elderly than in non-elderly patients. In order to maintain lean body mass among elderly patients, additional care and treatments are needed.
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Affiliation(s)
- Toru Aoyama
- Department of Gastrointestinal Surgery, Kanagawa Cancer Center, Yokohama, Japan .,Department of Surgery, Yokohama City University, Yokohama, Japan
| | - Yukio Maezawa
- Department of Gastrointestinal Surgery, Kanagawa Cancer Center, Yokohama, Japan.,Department of Surgery, Yokohama City University, Yokohama, Japan
| | - Takaki Yoshikawa
- Department of Gastrointestinal Surgery, Kanagawa Cancer Center, Yokohama, Japan .,Department of Surgery, Yokohama City University, Yokohama, Japan
| | - Kenki Segami
- Department of Gastrointestinal Surgery, Kanagawa Cancer Center, Yokohama, Japan.,Department of Surgery, Yokohama City University, Yokohama, Japan
| | - Kazuki Kano
- Department of Gastrointestinal Surgery, Kanagawa Cancer Center, Yokohama, Japan.,Department of Surgery, Yokohama City University, Yokohama, Japan
| | - Tsutomu Hayashi
- Department of Gastrointestinal Surgery, Kanagawa Cancer Center, Yokohama, Japan.,Department of Surgery, Yokohama City University, Yokohama, Japan
| | - Takanobu Yamada
- Department of Gastrointestinal Surgery, Kanagawa Cancer Center, Yokohama, Japan.,Department of Surgery, Yokohama City University, Yokohama, Japan
| | - Masakatsu Numata
- Department of Surgery, Yokohama City University, Yokohama, Japan
| | - Motohico Goda
- Department of Surgery, Yokohama City University, Yokohama, Japan
| | - Hiroshi Tamagawa
- Department of Surgery, Yokohama City University, Yokohama, Japan
| | - Tsutomu Sato
- Department of Gastrointestinal Surgery, Kanagawa Cancer Center, Yokohama, Japan.,Department of Surgery, Yokohama City University, Yokohama, Japan
| | - Norio Yukawa
- Department of Surgery, Yokohama City University, Yokohama, Japan
| | - Yasushi Rino
- Department of Surgery, Yokohama City University, Yokohama, Japan
| | - Munetaka Masuda
- Department of Surgery, Yokohama City University, Yokohama, Japan
| | - Takashi Ogata
- Department of Gastrointestinal Surgery, Kanagawa Cancer Center, Yokohama, Japan
| | - Haruhiko Cho
- Department of Gastrointestinal Surgery, Kanagawa Cancer Center, Yokohama, Japan
| | - Takashi Oshima
- Department of Gastrointestinal Surgery, Kanagawa Cancer Center, Yokohama, Japan.,Department of Surgery, Yokohama City University, Yokohama, Japan
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Pan Y, Chen K, Yu WH, Maher H, Wang SH, Zhao HF, Zheng XY. Laparoscopic gastrectomy for elderly patients with gastric cancer: A systematic review with meta-analysis. Medicine (Baltimore) 2018; 97:e0007. [PMID: 29465537 PMCID: PMC5841990 DOI: 10.1097/md.0000000000010007] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND Laparoscopic gastrectomy (LG) has been widely applied in patients with gastric cancer (GC). However, the safety and application value of LG in elderly patients with GC was still unclear. In this study, we aimed to evaluate the feasibility and safety of LG for elderly patients with GC using the meta-analysis. METHODS Studies comparing elderly patients and nonelderly patients who underwent LG for GC were reviewed and collected from the PubMed, EBSCO, Cochrane Library, and EMBASE. Outcomes such as operative results, postoperative recovery, and morbidity were compared and analyzed. The Review Manager 5.3 was used to portray the weighted mean difference (WMD) and odds ratio (OR) with a 95% confidence interval (CI). RESULTS Eleven observational studies with a total of 3275 patients were included. Compared with nonelderly patients, elderly patients had shorter operation time (WMD -10.46; 95% CI -17.06 to -3.86; P = .002), less retrieved lymph nodes (WMD -2.34; 95% CI -3.77 to -0.92; P = .001), delayed time to first flatus (WMD 0.31; 95% CI 0.10-0.51; P = .003), longer postoperative hospital stays (WMD 1.06; 95% CI 0.07-2.05; P = .04), higher risk for overall postoperative complication (OR 1.34; 95% CI 1.08-1.67; P = .009), nonsurgical postoperative complication (OR 1.98; 95% CI 1.24-3.15; P = .004), and postoperative pulmonary complication (OR: 3.09; 95% CI 1.68-5.68; P < .001). There was no significance between nonelderly patients and elderly patients regarding the estimated blood loss, incidences of surgical postoperative complication, surgical site infection, and ileus (P > .05). CONCLUSION Outcomes of LG for elderly patients were comparable to those in nonelderly patients. Age alone should not preclude LG in elderly patients.
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Affiliation(s)
- Yu Pan
- Department of General Surgery, Sir Run Run Shaw Hospital, School of Medicine
| | - Ke Chen
- Department of General Surgery, Sir Run Run Shaw Hospital, School of Medicine
| | - Wei-hua Yu
- Department of General Surgery, Sir Run Run Shaw Hospital, School of Medicine
| | - Hendi Maher
- School of Medicine, Zhejiang University, Hangzhou, China
| | - Sui-han Wang
- Department of General Surgery, Sir Run Run Shaw Hospital, School of Medicine
| | - Hang-fen Zhao
- Department of General Surgery, Sir Run Run Shaw Hospital, School of Medicine
| | - Xue-yong Zheng
- Department of General Surgery, Sir Run Run Shaw Hospital, School of Medicine
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Pisanu A, Montisci A, Piu S, Uccheddu A. Curative Surgery for Gastric Cancer in the Elderly: Treatment Decisions, Surgical Morbidity, Mortality, Prognosis and Quality of Life. TUMORI JOURNAL 2018; 93:478-84. [DOI: 10.1177/030089160709300512] [Citation(s) in RCA: 39] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Aims and Background Surgical risk is deemed to be higher in the aged population because there are often comorbidities that may affect the postoperative result. This consideration is important for the treatment decision-making for gastric cancer in the elderly. The aim of this study was to identify factors influencing mortality, morbidity, survival and quality of life after curative surgery for gastric cancer in patients aged 75 years and older, and to plan their appropriate management. Methods and Study Design From January 1993 to December 2004, 135 patients underwent surgery at our department because of gastric cancer. Ninety-four of these patients (69.6%) underwent potentially curative gastrectomy. A cross-sectional study of 23 patients aged 75 years and older and 71 younger patients who underwent curative gastrectomy was carried out: patient characteristics, tumor characteristics, management, morbidity, mortality, survival, and quality of life were evaluated. Results Elderly patients had significantly more comorbidities and a poorer nutritional status than younger patients. The surgical procedures were similar in both groups and the overall morbidity rate was 27.9% and the overall mortality rate 8.5%. Medical mortality was significantly higher in elderly patients, and the presence of comorbidities was the only independent factor affecting mortality. The 5-year survival rate was 56.2% in the older group versus 62.1% in the younger group and tumor stage was the only prognostic factor influencing survival. Quality of life after surgery was similar in both groups. The significantly better postoperative functional outcome after subtotal gastrectomy suggested a better compliance of elderly patients with subtotal than total gastrectomy. Conclusions In the elderly, surgical strategies must be modulated on the basis of comorbidities, tumor stage and future quality of life. Since elderly patients have no worse prognosis than younger patients, age is not a contraindication to curative resection for gastric cancer. Subtotal gastrectomy should be the procedure of choice mainly in elderly patients as it offers better quality of life.
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Affiliation(s)
- Adolfo Pisanu
- Department of Surgery, Clinica Chirurgica of the University of Cagliari, Cagliari, Italy
| | - Alessandro Montisci
- Department of Surgery, Clinica Chirurgica of the University of Cagliari, Cagliari, Italy
| | - Sara Piu
- Department of Surgery, Clinica Chirurgica of the University of Cagliari, Cagliari, Italy
| | - Alessandro Uccheddu
- Department of Surgery, Clinica Chirurgica of the University of Cagliari, Cagliari, Italy
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Choo JW, Ju Y, Lim H, Youn SH, Soh JS, Park JW, Kang HS, Kim SE, Moon SH, Kim JH, Park CK, Ha HI, Kim MJ, Kim KC, Cho JW. Is it beneficial to perform surgical resection in elderly patients more than 80 years old with advanced gastric cancer? Scand J Gastroenterol 2017; 52:1057-1064. [PMID: 28639835 DOI: 10.1080/00365521.2017.1339828] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
OBJECTIVES With the aging population, the number of elderly patients diagnosed with gastric cancer is increasing. However, determining treatment strategies for elderly patients with gastric cancer is controversial. The aim of this study is to evaluate the usefulness of surgical treatment on elderly patients aged ≥80 years with advanced gastric cancer. METHODS A total of 147 elderly patients who were diagnosed with advanced gastric cancer from August 2001 to December 2015 were retrospectively analyzed. We compared the clinicopathological features and prognoses of 94 elderly patients (80-85 years) and 53 extreme-elderly patients (≥86 years) according to treatment modalities. RESULTS In the elderly group, the 3-year overall survival (OS) rates of the surgical resection group and supportive care group were 42.1% and 4.0%, respectively (p < .001). In the extreme-elderly group, the 3-year OS rates of the surgical resection group and supportive care group were 36.4% and 8.0%, respectively (p = .028). The post-operative mortality rate of the elderly group and extreme-elderly group was 5.6% and 9.1%, respectively. In the analysis of risk factors associated with survival, surgical resection was a significantly good prognostic factor in the elderly group (hazard ratio [HR] = 0.277; p = .003) compared with supportive care. In the extreme-elderly group, surgical resection was associated with good prognosis but did not reach statistical significance (HR = 0.491; p = .099). CONCLUSIONS These results suggest that elderly patients aged 80-85 years with advanced gastric cancer could expect a better prognosis with surgical resection. However, extreme-elderly patients aged ≥86 years should consider the risks and benefits of surgical treatment.
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Affiliation(s)
- Jin Woo Choo
- a Department of Internal Medicine , University of Hallym College of Medicine, Hallym University Sacred Heart Hospital , Anyang , Republic of Korea
| | - Yeonmi Ju
- a Department of Internal Medicine , University of Hallym College of Medicine, Hallym University Sacred Heart Hospital , Anyang , Republic of Korea
| | - Hyun Lim
- a Department of Internal Medicine , University of Hallym College of Medicine, Hallym University Sacred Heart Hospital , Anyang , Republic of Korea
| | - Sung Hee Youn
- a Department of Internal Medicine , University of Hallym College of Medicine, Hallym University Sacred Heart Hospital , Anyang , Republic of Korea
| | - Jae Seung Soh
- a Department of Internal Medicine , University of Hallym College of Medicine, Hallym University Sacred Heart Hospital , Anyang , Republic of Korea
| | - Ji Won Park
- a Department of Internal Medicine , University of Hallym College of Medicine, Hallym University Sacred Heart Hospital , Anyang , Republic of Korea
| | - Ho Suk Kang
- a Department of Internal Medicine , University of Hallym College of Medicine, Hallym University Sacred Heart Hospital , Anyang , Republic of Korea
| | - Sung Eun Kim
- a Department of Internal Medicine , University of Hallym College of Medicine, Hallym University Sacred Heart Hospital , Anyang , Republic of Korea
| | - Sung Hoon Moon
- a Department of Internal Medicine , University of Hallym College of Medicine, Hallym University Sacred Heart Hospital , Anyang , Republic of Korea
| | - Jong Hyeok Kim
- a Department of Internal Medicine , University of Hallym College of Medicine, Hallym University Sacred Heart Hospital , Anyang , Republic of Korea
| | - Choong Kee Park
- a Department of Internal Medicine , University of Hallym College of Medicine, Hallym University Sacred Heart Hospital , Anyang , Republic of Korea
| | - Hong Il Ha
- b Department of Radiology , University of Hallym College of Medicine, Hallym University Sacred Heart Hospital , Anyang , Republic of Korea
| | - Min-Jeong Kim
- b Department of Radiology , University of Hallym College of Medicine, Hallym University Sacred Heart Hospital , Anyang , Republic of Korea
| | - Kab-Choong Kim
- c Department of Surgery , University of Hallym College of Medicine, Hallym University Sacred Heart Hospital , Anyang , Republic of Korea
| | - Ji Woong Cho
- c Department of Surgery , University of Hallym College of Medicine, Hallym University Sacred Heart Hospital , Anyang , Republic of Korea
- d Department of Surgery , University of Hallym College of Medicine, Kangnam Sacred Heart Hospital , Seoul , Republic of Korea
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9
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Mikami K, Hirano K, Futami K, Maekawa T. Gastrectomy with limited surgery for elderly patients with gastric cancer. Asian J Surg 2016; 41:65-72. [PMID: 27693065 DOI: 10.1016/j.asjsur.2016.09.002] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2016] [Revised: 08/18/2016] [Accepted: 09/02/2016] [Indexed: 01/15/2023] Open
Abstract
BACKGROUND/OBJECTIVE Elderly patients with gastric cancer can receive standard gastrectomy or gastrectomy with reduced nodal dissection, i.e., limited surgery, in order to prevent postoperative complications. This study evaluated the feasibility of gastrectomy with limited surgery for elderly patients with gastric cancer. METHODS A total of 267 elderly patients (≥70 years old) were divided into two groups according to the level of nodal dissection: patients who received nodal dissection according to guidelines were included in the standard surgery group (standard group), and those who received reduced nodal dissection were included in the limited surgery group (limited group). The surgical outcomes of the two groups were compared. RESULTS There were 170 patients in the standard group and 97 patients in the limited group. The limited group had significantly poorer nutrition status and a significantly higher proportion with comorbidities. Morbidity and mortality were similar in both groups. Multivariate analysis showed that the overall survival rates were significantly worse in patients with advanced age, male gender, low body mass index, low prognostic nutrition index, and higher tumor stage. The disease-specific survival rate was significantly lower in the limited group than in the standard group (p<0.001). CONCLUSION Gastrectomy according to the gastric treatment guidelines for elderly patients with gastric cancer is recommended. Elderly male patients with poor nutrition have poor prognosis; prognostic nutrition index <40. Limited surgery is a treatment option for such patients.
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Affiliation(s)
- Koji Mikami
- Department of Surgery, Fukuoka University Chikushi Hospital, 1-1-1 Zokumyoin, Chikushino City, Fukuoka 818-8502, Japan.
| | - Kimikazu Hirano
- Department of Surgery, Fukuoka University Chikushi Hospital, 1-1-1 Zokumyoin, Chikushino City, Fukuoka 818-8502, Japan
| | - Kitarou Futami
- Department of Surgery, Fukuoka University Chikushi Hospital, 1-1-1 Zokumyoin, Chikushino City, Fukuoka 818-8502, Japan
| | - Takafumi Maekawa
- Department of Surgery, Fukuoka University Chikushi Hospital, 1-1-1 Zokumyoin, Chikushino City, Fukuoka 818-8502, Japan
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Passot G, Vaudoyer D, Messager M, Brudvik KW, Kim BJ, Mariette C, Glehen O. Is Extended Lymphadenectomy Needed for Elderly Patients With Gastric Adenocarcinoma? Ann Surg Oncol 2016; 23:2391-7. [PMID: 27169773 DOI: 10.1245/s10434-016-5260-x] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2015] [Indexed: 12/31/2022]
Abstract
BACKGROUND Extensive surgery is associated with greater mortality for elderly patients. For gastric adenocarcinoma (GA), it is unclear whether the benefit of an extended lymphadenectomy in this population outweighs the associated risks. This study aimed to determine the impact of lymphadenectomy on postoperative outcomes and survival for the elderly. OBJECTIVE To determine the impact of lymphadenectomy on postoperative outcomes and survival for elderly. METHODS From a cohort of 19 centers, patients who underwent resection of GA with curative intent between 1997 and 2010 were included in this study. Lymphadenectomy was defined according to the total number of lymph nodes in the surgical specimen (limited, <15; intermediate, 15-25; extended, >25). Postoperative outcomes and survival were compared between elderly (≥75 years) and younger patients and regarding the extent of lymphadenectomy for the elderly. RESULTS Of 1348 patients, 386 were elderly. The elderly presented with a higher American Society of Anesthesiologist (ASA) score (ASA 3-4: 45 vs. 16.5 %; p < 0.001) as well as greater postoperative morbidity (45 vs. 37 %; p = 0.009) and mortality (8 vs. 2.5 %; p < 0.001) despite less aggressive treatment including less neoadjuvant chemotherapy (5 vs. 20 %; p < 0.001) and adjuvant chemotherapy (7 vs. 44 %; p < 0.001), fewer total gastrectomies (41.5 vs. 60 %; p < 0.001), and less extended lymphadenectomy (38 vs. 48.5 %; p < 0.001). Among the elderly patients, limited lymphadenectomy (n = 116), intermediate lymphadenectomy (n = 125), and extended lymphadenectomy (n = 145) were comparable with respect to tumor stage, perioperative treatment, morbidity, and mortality. For the elderly patients, overall survival (OS) was 30.8 months, and disease-specific survival (DSS) was 63.9 months. The extent of the lymphadenectomy did not have an impact on OS or DSS for the elderly patients. CONCLUSION The expected benefit in terms of long-term survival did not justify an extended lymphadenectomy for elderly patients.
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Affiliation(s)
- Guillaume Passot
- Department of General and Oncological Surgery, Hospices Civils de Lyon, University Hospital Lyon Sud, Pierre Bénite, France. .,EMR 3738, Lyon 1 University, Lyon, France.
| | - Delphine Vaudoyer
- Department of General and Oncological Surgery, Hospices Civils de Lyon, University Hospital Lyon Sud, Pierre Bénite, France
| | - Mathieu Messager
- Department of Digestive and Oncological Surgery, University Hospital C. Huriez, Lille, France
| | - Kristoffer W Brudvik
- Department of Hepato-Pancreato-Biliary Surgery, Oslo University Hospital, Rikshospitalet, Norway
| | - Bradford J Kim
- Department of Surgery, Indiana University School of Medicine, Indianapolis, IN, USA
| | - Christophe Mariette
- Department of Digestive and Oncological Surgery, University Hospital C. Huriez, Lille, France
| | - Olivier Glehen
- Department of General and Oncological Surgery, Hospices Civils de Lyon, University Hospital Lyon Sud, Pierre Bénite, France.,EMR 3738, Lyon 1 University, Lyon, France
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Kang SC, Kim HI, Kim MG. Low Serum Albumin Level, Male Sex, and Total Gastrectomy Are Risk Factors of Severe Postoperative Complications in Elderly Gastric Cancer Patients. J Gastric Cancer 2016; 16:43-50. [PMID: 27104026 PMCID: PMC4834620 DOI: 10.5230/jgc.2016.16.1.43] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/24/2016] [Revised: 03/21/2016] [Accepted: 03/21/2016] [Indexed: 12/13/2022] Open
Abstract
Purpose It is well known that old age is a risk factor for postoperative complications. Therefore, this study aimed to explore the risk factors for poor postoperative surgical outcomes in elderly gastric cancer patients. Materials and Methods Between January 2006 and December 2015, 247 elderly gastric cancer patients who underwent curative gastrectomy were reviewed. In this study, an elderly patient was defined as a patient aged ≥65 years. All possible variables were used to explore the risk factors for poor early surgical outcomes in elderly gastric cancer patients. Results Based on multivariate analyses of preoperative risk factors, preoperative low serum albumin level (<3.5 g/dl) and male sex showed statistical significance in predicting severe postoperative complications. Additionally, in an analysis of surgery-related risk factors, total gastrectomy was a risk factor for severe postoperative complications. Conclusions Our study findings suggest that low serum albumin level, male sex, and total gastrectomy could be risk factors of severe postoperative complications in elderly gastric cancer patients. Therefore, surgeons should work carefully in cases of elderly gastric cancer patients with low preoperative serum albumin level and male sex. We believe that efforts should be made to avoid total gastrectomy in elderly gastric cancer patients.
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Affiliation(s)
- Sung Chan Kang
- Department of Surgery, Hanyang University Guri Hospital, Hanyang University College of Medicine, Guri, Korea
| | - Hyun Il Kim
- Department of Surgery, Hanyang University Guri Hospital, Hanyang University College of Medicine, Guri, Korea
| | - Min Gyu Kim
- Department of Surgery, Hanyang University Guri Hospital, Hanyang University College of Medicine, Guri, Korea
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Zhou CJ, Chen FF, Zhuang CL, Pang WY, Zhang FY, Huang DD, Wang SL, Shen X, Yu Z. Feasibility of radical gastrectomy for elderly patients with gastric cancer. Eur J Surg Oncol 2016; 42:303-11. [DOI: 10.1016/j.ejso.2015.11.013] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2015] [Revised: 10/30/2015] [Accepted: 11/20/2015] [Indexed: 12/30/2022] Open
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Role of robot-assisted distal gastrectomy compared to laparoscopy-assisted distal gastrectomy in suprapancreatic nodal dissection for gastric cancer. Surg Endosc 2015; 30:1547-52. [PMID: 26169636 DOI: 10.1007/s00464-015-4372-x] [Citation(s) in RCA: 41] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2015] [Accepted: 06/23/2015] [Indexed: 12/18/2022]
Abstract
PURPOSE Despite theoretical advantages, no clear benefit was proven for initial application of robotic surgery for gastric cancer so far. The aim of this analysis was to examine the role of robotic surgery regarding nodal dissection technically demanding areas compared to conventional laparoscopic surgery. METHODS This analysis included 87 patients who underwent robot-assisted distal gastrectomy (RADG) and 288 patients who underwent laparoscopy-assisted distal gastrectomy (LADG) at the National Cancer Center, Korea, between February 2009 and September 2011. Clinicopathologic data, surgery-related data, postoperative morbidity, and pathologic data for each nodal station were analyzed. RESULTS Time to flatulence was 3.5 ± 0.8 days for RADG and 3.8 ± 0.8 days for LADG (P = 0.01). Postoperative hospital stay was 6.7 ± 1.0 days in RADG and 7.4 ± 2.4 days in LADG (P < 0.001).The number of dissected lymph nodes was 37.1 ± 12.9 in the RADG group and 34.1 ± 12.1 in the LADG group (P = 0.044). In patients undergoing D2 gastrectomy, the number of dissected lymph nodes in the N2 area was 16.3 ± 7.7 for RADG and 13.2 ± 5.3 for LADG (P = 0.001). The number of dissected lymph nodes around the splenic artery area was 2.9 ± 2.9 in RADG and 2.2 ± 2.0 in LADG (P = 0.04). Regarding postoperative complications, there was no statistically significant difference [five patients (5.7%) in RADG and 26 patients (9%) in LADG) (P = 0.330)]. CONCLUSION RADG could provide an advantage over LADG in the dissection of the N2 area lymph nodes, especially around the splenic artery area.
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Jeong SH, Kim YW, Yu W, Lee SH, Park YK, Park SH, Jeong IH, Lee SE, Park Y, Lee YJ. High morbidity in myocardial infarction and heart failure patients after gastric cancer surgery. World J Gastroenterol 2015; 21:6631-6638. [PMID: 26074701 PMCID: PMC4458773 DOI: 10.3748/wjg.v21.i21.6631] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/31/2014] [Revised: 02/03/2015] [Accepted: 03/27/2015] [Indexed: 02/06/2023] Open
Abstract
AIM: To evaluate to morbidity and mortality differences between 4 underlying heart diseases, myocardial infarction (MI), angina pectoris (Angina), heart failure (HF), and atrial fibrillation (AF), after radical surgery for gastric cancer.
METHODS: We retrospectively collected data from 221 patients of a total of 15167 patients who underwent radical gastrectomy and were preoperatively diagnosed with a history of Angina, MI, HF, or AF in 8 hospitals.
RESULTS: We find that the total morbidity rate is significantly higher in the MI group (44%) than the Angina (15.7%), AF (18.8%), and HF (23.1%) groups (P < 0.01). Moreover, we note that the risk for postoperative cardiac problems is higher in patients with a history of HF (23.1%) than patients with a history of Angina (2.2%), AF (4.3%), or MI (6%; P = 0.01). The HF and MI groups each have 1 case of cardiogenic mortality.
CONCLUSION: We conclude that MI patients have a higher risk of morbidity, and HF patients have a higher risk of postoperative cardiac problems than Angina or AF.
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Sakurai K, Muguruma K, Nagahara H, Kimura K, Toyokawa T, Amano R, Kubo N, Tanaka H, Ohtani H, Yashiro M, Maeda K, Ohira M, Hirakawa K. The outcome of surgical treatment for elderly patients with gastric carcinoma. J Surg Oncol 2015; 111:848-54. [PMID: 25753213 PMCID: PMC5023995 DOI: 10.1002/jso.23896] [Citation(s) in RCA: 41] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2014] [Accepted: 01/07/2015] [Indexed: 12/12/2022]
Abstract
BACKGROUND The aim of this study was to clarify the operative mortality and long-term survival of gastrectomy for elderly patients with gastric cancer. METHODS A total of 461 patients who underwent gastrectomy for gastric cancer in our hospital were classified as elderly group (≥80 years-old, 95 patients) and control group (60-69 years-old, 366 patients). RESULTS The frequency of comorbidities was significantly (P < 0.05) higher in elderly group (74.7%) than that in the control group (49.5%). No significant difference of the postoperative complication rate was found between the elderly group (23.2%) and the control group (23.2%). Adjuvant chemotherapy was 9.5% in the elderly group, which was significantly less than 29.0% of the control group (P < 0.05). Stage II and III elderly patients had worse disease specific survival (DSS) than controls did. In the elderly, overall survival (OS) was significantly worse than DSS in stage I patients (P < 0.05). CONCLUSIONS The operative complication rate of elderly patients was comparable to the control group. Comorbidity and occurrence of secondary malignant disease should be followed for elderly patients at stage I. For stage II and III disease patients, a novel drug which is acceptable for the elderly is needed as a postoperative therapy.
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Affiliation(s)
- Katsunobu Sakurai
- Department of Surgical OncologyOsaka City University Graduate School of MedicineOsakaJapan
| | - Kazuya Muguruma
- Department of Surgical OncologyOsaka City University Graduate School of MedicineOsakaJapan
| | - Hisashi Nagahara
- Department of Surgical OncologyOsaka City University Graduate School of MedicineOsakaJapan
| | - Kenjiro Kimura
- Department of Surgical OncologyOsaka City University Graduate School of MedicineOsakaJapan
| | - Takahiro Toyokawa
- Department of Surgical OncologyOsaka City University Graduate School of MedicineOsakaJapan
| | - Ryosuke Amano
- Department of Surgical OncologyOsaka City University Graduate School of MedicineOsakaJapan
| | - Naoshi Kubo
- Department of Surgical OncologyOsaka City University Graduate School of MedicineOsakaJapan
| | - Hiroaki Tanaka
- Department of Surgical OncologyOsaka City University Graduate School of MedicineOsakaJapan
| | - Hiroshi Ohtani
- Department of Surgical OncologyOsaka City University Graduate School of MedicineOsakaJapan
| | - Masakazu Yashiro
- Department of Surgical OncologyOsaka City University Graduate School of MedicineOsakaJapan
| | - Kiyoshi Maeda
- Department of Surgical OncologyOsaka City University Graduate School of MedicineOsakaJapan
| | - Masaichi Ohira
- Department of Surgical OncologyOsaka City University Graduate School of MedicineOsakaJapan
| | - Kosei Hirakawa
- Department of Surgical OncologyOsaka City University Graduate School of MedicineOsakaJapan
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Mickevicius A, Ignatavicius P, Markelis R, Parseliunas A, Butkute D, Kiudelis M, Endzinas Z, Maleckas A, Dambrauskas Z. Trends and results in treatment of gastric cancer over last two decades at single East European centre: a cohort study. BMC Surg 2014; 14:98. [PMID: 25428767 PMCID: PMC4258015 DOI: 10.1186/1471-2482-14-98] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2014] [Accepted: 11/17/2014] [Indexed: 12/26/2022] Open
Abstract
BACKGROUND A steady decline in gastric cancer mortality rate over the last few decades is observed in Western Europe. However it is still not clear if this trend applies to Eastern Europe where high incidence rate of gastric cancer is observed. METHODS This was a retrospective non-randomized, single center, cohort study. During the study period 557 consecutive patients diagnosed with gastric cancer in which curative operation was performed met the inclusion criteria. The study population was divided into two groups according to two equal time periods: 01-01-1994 - 31-12-2000 (Group I - 273 patients) and 01-01-2001 - 31-12-2007 (Group II - 284 patients). Primary (five-year survival rate) and secondary (postoperative complications, 30-day mortality rate and length of hospital stay) endpoints were evaluated and compared. RESULTS Rate of postoperative complications was similar between the groups, except for Grade III (Clavien-Dindo grading system for the classification of surgical complications) complications that were observed at significantly lower rates in Group II (26 (9.5%) vs. 11 (3.9%), p = 0.02). Length of hospital stay was significantly (p = 0.001) shorter (22.6 ± 28.9 vs. 16.2 ± 17.01 days) and 30-day mortality was significantly (p = 0.02) lower (15 (5.5%) vs. 4 (1.4%)) in Group II. Similar rates of gastric cancer related mortality were observed in both groups (92.3% vs. 90.7%). However survival analysis revealed significantly (p = 0.02) better overall 5-year survival rate in Group II (35.6%, 101 of 284) than in Group I (23.4%, 64 of 273). There was no difference in 5-year survival rate when comparing different TNM stages. CONCLUSIONS Gastric cancer treatment results remain poor despite decreasing early postoperative mortality rates, shortening hospital stay and improved overall survival over the time. Prognosis of treatment of gastric cancer depends mainly on the stage of the disease. Absence of screening programs and lack of clinical symptoms in early stages of gastric cancer lead to circumstances when most of the patients presenting with advanced stage of the disease can expect a median survival of less than 30 months even after surgery with curative intent.
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Affiliation(s)
- Antanas Mickevicius
- />Department of Surgery, Lithuanian University of Health Sciences, Eiveniu Str. 2, Kaunas, LT-50009 Lithuania
| | - Povilas Ignatavicius
- />Department of Surgery, Lithuanian University of Health Sciences, Eiveniu Str. 2, Kaunas, LT-50009 Lithuania
- />Laboratory of Surgical Gastroenterology, Institute for Digestive System Research, Lithuanian University of Health Sciences, Eivenių str. 2, Kaunas, LT-50009 Lithuania
| | - Rytis Markelis
- />Department of Surgery, Lithuanian University of Health Sciences, Eiveniu Str. 2, Kaunas, LT-50009 Lithuania
| | - Audrius Parseliunas
- />Department of Surgery, Lithuanian University of Health Sciences, Eiveniu Str. 2, Kaunas, LT-50009 Lithuania
| | - Dainora Butkute
- />Department of Oncology, Lithuanian University of Health Sciences, Eivenių str. 2, Kaunas, LT-50009 Lithuania
| | - Mindaugas Kiudelis
- />Department of Surgery, Lithuanian University of Health Sciences, Eiveniu Str. 2, Kaunas, LT-50009 Lithuania
| | - Zilvinas Endzinas
- />Department of Surgery, Lithuanian University of Health Sciences, Eiveniu Str. 2, Kaunas, LT-50009 Lithuania
| | - Almantas Maleckas
- />Department of Surgery, Lithuanian University of Health Sciences, Eiveniu Str. 2, Kaunas, LT-50009 Lithuania
| | - Zilvinas Dambrauskas
- />Department of Surgery, Lithuanian University of Health Sciences, Eiveniu Str. 2, Kaunas, LT-50009 Lithuania
- />Laboratory of Surgical Gastroenterology, Institute for Digestive System Research, Lithuanian University of Health Sciences, Eivenių str. 2, Kaunas, LT-50009 Lithuania
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Shin HS, Oh SJ, Suh BJ. Factors related to morbidity in elderly gastric cancer patients undergoing gastrectomies. J Gastric Cancer 2014; 14:173-9. [PMID: 25328762 PMCID: PMC4199884 DOI: 10.5230/jgc.2014.14.3.173] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/05/2014] [Revised: 08/21/2014] [Accepted: 08/22/2014] [Indexed: 01/19/2023] Open
Abstract
Purpose The prevalence of gastric cancer in the elderly is increasing. The purpose of this study was to clarify factors related to morbidity following gastric cancer surgery in elderly patients. Materials and Methods For this study, data from 411 patients who underwent curative gastrectomies with lymph node dissections between March 2010 and January 2013 were retrospectively studied using a prospectively designed database. Patients were divided into 2 groups (<70 years vs. ≥70 years). For each group, perioperative factors were analyzed to determine if they were associated with postoperative morbidity and mortality. Results Comorbidities were more prevalent in the elderly group (≥70 years). Intraoperative and postoperative transfusions were also more frequently required in the elderly group. There was no significant difference in the number of retrieved lymph nodes between the 2 groups (44.3 vs. 46.6 nodes). In a comparison of the elderly versus non-elderly groups, the postoperative morbidity rates were 22.7% versus 8.9% (P<0.001) and the postoperative mortality rates were 4.2% versus 0% (P=0.002), respectively. Of the possible non-surgical complications, pulmonary problems were predominately found in the elderly group (P<0.001). Surgical complications were evenly distributed between the 2 groups (P=0.463). Postoperative morbidity was significantly associated with older age and postoperative transfusion. Multivariate analysis showed that higher body mass index (BMI) and postoperative transfusion were important factors associated with postoperative complications in the elderly group. Conclusions Pulmonary complications were frequently problematic in elderly patients. Higher BMI and postoperative transfusion were significant risk factors for postoperative complications in elderly patients with gastric cancer.
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Affiliation(s)
- Ha Song Shin
- Department of Surgery, Haeundae Paik Hospital, Inje University College of Medicine, Busan, Korea
| | - Sung Jin Oh
- Department of Surgery, Haeundae Paik Hospital, Inje University College of Medicine, Busan, Korea
| | - Byoung Jo Suh
- Department of Surgery, Haeundae Paik Hospital, Inje University College of Medicine, Busan, Korea
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Namikawa T, Kitagawa H, Yamatsuji T, Naomoto Y, Kobayashi M, Hanazaki K. Pre-emptive treatment of fungal infection based on plasma β-D-glucan levels after gastric surgery for gastric cancer in elderly patients. J Gastroenterol Hepatol 2013; 28:1457-1461. [PMID: 23574148 DOI: 10.1111/jgh.12219] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 03/31/2013] [Indexed: 02/05/2023]
Abstract
BACKGROUND AND AIM Invasive fungal infection (IFI) related to surgery in elderly patients is often associated with high morbidity and mortality. The aim of the present study was to determine 1,3-β-D-glucan (βDG) levels after gastric cancer surgery in elderly patients and to prospectively evaluate the efficacy of pre-emptive antifungal therapy using βDG as an aid for the early diagnosis of IFI. METHODS In all, 81 patients aged ≥70 years who had undergone gastric cancer surgery between 2009 and 2011 were prospectively enrolled in the study. Patients with plasma βDG levels >11 pg/mL (the cut-off value) were randomly assigned to either receive antifungal treatment or not (n=13 in each group). Postoperative outcomes were assessed using various clinical parameters. RESULTS After gastric cancer surgery, plasma βDG levels were ≥11 pg/mL in 26 of 81 elderly patients (32.1%). Of the βDG-positive patients, significantly more had stages III and IV rather than stages I and II disease (44.1% vs 23.4%, respectively; P=0.049). Fever on postoperative day 8 was significantly reduced in the pre-emptive antifungal-treated group than in the control group (36.8°C vs 37.2°C, respectively; P=0.045). However, there were no significant differences in mortality, morbidity, βDG levels, white blood cell count, and C-reactive protein levels between the two groups. CONCLUSIONS Pre-emptive antifungal treatment based on βDG after gastric surgery in elderly patients may help reduce the incidence of postoperative fever and suppress IFI. However, this needs to be confirmed in a larger prospective randomized, controlled trial.
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Affiliation(s)
- Tsutomu Namikawa
- Department of Surgery, Kochi Medical School, Nankoku, Kochi, Japan
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Pata G, Solaini L, Roncali S, Pasini M, Ragni F. Impact of obesity on early surgical and oncologic outcomes after total gastrectomy with "over-D1" lymphadenectomy for gastric cancer. World J Surg 2013; 37:1072-1081. [PMID: 23408049 DOI: 10.1007/s00268-013-1942-8] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Abstract
INTRODUCTION The purpose of the present study was to assess the impact of body mass index (BMI) on perioperative and pathologic outcomes after total gastrectomy with "over-D1" dissection for gastric cancer. METHODS Data on 161 patients undergoing total gastrectomy between 2005 and 2011 were reviewed. Patients were grouped into three categories by BMI: BMI < 25 kg/m(2) (63 normal-weight patients; 39.1 %), BMI ≥ 25-<30 kg/m(2) (73 overweight patients; 45.3 %), and BMI ≥ 30 kg/m(2) (25 obese patients; 15.6 %) and matched for the analysis of perioperative and cancer-related outcomes. RESULTS Operative time was longer for obese patients. Medical (mainly pulmonary) and surgical (mainly bleeding and wound infection) complications occurred more frequently in overweight/obese subjects. However, they were mostly managed conservatively (grade I-II in the Clavien-Dindo classification). The overall postoperative mortality was 0.9 %. Multivariate analysis identified the American Society of Anesthesiologists score and splenectomy, but not obesity, as independent risk factors for postoperative complications. The median number of lymph nodes retrieved differed significantly from group to group: obese 21 (IQR 18-26), versus overweight 24, versus normal weight 28 (p = 0.031). No difference was found in lymph node ratio and cancer-related parameters. CONCLUSIONS Obese patients with operable gastric cancer can be candidates for standard extensive surgical resection, provided that pre-existing co-morbidities and potential intraoperative and postoperative complications are considered.
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Affiliation(s)
- Giacomo Pata
- 2nd Division of General Surgery, Department of Medical and Surgical Sciences, Brescia Civic Hospital, P. le Spedali Civili 1, 25124 Brescia, Italy.
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Pata G, Solaini L, Roncali S, Pasini M, Ragni F. Total gastrectomy with "over-D1" lymph node dissection: what is the actual impact of age? Am J Surg 2012; 204:732-740. [PMID: 22633445 DOI: 10.1016/j.amjsurg.2012.02.013] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2011] [Revised: 02/27/2012] [Accepted: 02/27/2012] [Indexed: 01/01/2023]
Abstract
BACKGROUND We aimed to evaluate risk factors for postoperative complications after total gastrectomy with "over-D1" lymphadenectomy. METHODS Data on 161 patients (54 cases aged >75 years: elderly group) operated on between 2005 and 2011 were reviewed. Risk factors analyzed for complications (Clavien-Dindo classification) included sex, age, American Society of Anesthesiologists (ASA) grade, body mass index (BMI), pTNM stage, long-term antiplatelets therapy, operative time, and splenectomy. RESULTS The median age of the study population was 71 (interquartile range [IQR] 62-77) years (79 [range 76-90] years for elderly patients vs 65 [range 33-75] years for the control group, P < .0001). ASA classification was the only baseline characteristic significantly different in the intergroup analysis; 79.6% of the elderly patients were in ASA class III to IV versus 39.2% of the controls (P < .0001). Univariate analysis showed that patient age, ASA score, BMI, and splenectomy were predictive of postoperative complications. Multivariate analysis confirmed ASA score and splenectomy as independent risk-factors. CONCLUSIONS Regardless of age, fit elderly patients with operable gastric cancer should be candidates for the recommended standard extensive surgical resection provided that pre-existing comorbidities are considered.
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Affiliation(s)
- Giacomo Pata
- Department of Medical and Surgical Sciences, 2nd Division of General Surgery, Brescia Civic Hospital, Brescia, Italy.
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Abstract
Elderly patients constitute the largest group in oncologic medical practice, despite the fact that in solid cancers treated operatively, many patients are denied standard therapies and where such decision making is based solely on age. The “natural” assumptions that we have are often misleading; namely, that the elderly cannot tolerate complex or difficult procedures, chemotherapy, or radiation schedules; that their overall predictable medical health determines survival (and not the malignancy); or that older patients typically have less aggressive tumors. Clearly, patient selection and a comprehensive geriatric assessment is key where well-selected cases have the same cancer-specific survival as younger cohorts in a range of tumors as outlined including upper and lower gastrointestinal malignancy, head and neck cancer, and breast cancer. The assessment of patient fitness for surgery and adjuvant therapies is therefore critical to outcomes, where studies have clearly shown that fit older patients experience the same benefits and toxicities of chemotherapy as do younger patients and that when normalized for preexisting medical conditions,that older patients tolerate major operative procedures designed with curative oncological intent. At present, our problem is the lack of true evidence-based medicine specifically designed with age in mind, which effectively limits surgical decision making in disease-based strategies. This can only be achieved by the utilization of more standardized, comprehensive geriatric assessments to identify vulnerable older patients, aggressive pre-habilitation with amelioration of vulnerability causation, improvement of patient-centered longitudinal outcomes, and an improved surgical and medical understanding of relatively subtle decreases in organ functioning, social support mechanisms and impairments of health-related quality of life as a feature specifically of advanced age.
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Affiliation(s)
- Andrew P Zbar
- Department of Surgery and Transplantation, Chaim Sheba Medical Center, Tel-Aviv, Israel 52621.
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22
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Seo SH, Hur H, An CW, Yi X, Kim JY, Han SU, Cho YK. Operative risk factors in gastric cancer surgery for elderly patients. J Gastric Cancer 2011; 11:116-121. [PMID: 22076212 PMCID: PMC3204490 DOI: 10.5230/jgc.2011.11.2.116] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/26/2011] [Accepted: 05/30/2011] [Indexed: 12/29/2022] Open
Abstract
PURPOSE Gastric cancer surgery is a common operation in East Asia, such as Korea and Japan, and there has been a significant increase in the need for this procedure due to the aging population. As a result, surgery for the treatment of gastric cancer for elderly patients is expected to increase. This study examined the effect of old age on gastric cancer surgery, and analyzed the operative risk factors for elderly patients. MATERIALS AND METHODS From November 2008 to August 2010, 590 patients, who underwent a curative resection for gastric cancers, were enrolled. Patients who underwent palliative or emergency surgery were excluded. A retrospective analysis of the correlation between surgical outcomes and age was performed. The elderly were defined as patients who were over the age of 65 years. RESULTS The mean age of all patients was 58.3 years, and complications occurred in 87 cases (14.7%). The most common complication was wound infection and severe complications requiring surgical, endoscopic, or radiologic intervention developed in 52 cases (8.8%). The rate of complications increased with increasing age of the patients. Univariate analysis revealed age, comorbidity, extent of resection, operation time, and combined resection to be associated with surgical complications. In particular, age over 75 years old, operation time, and comorbidity were predictive factors in multivariate analysis. In the elderly, only comorbidity was associated with surgical complications. CONCLUSIONS The patients' age is the most important factor for predicting surgical complications. Surgeons should pay an attention to the performance of gastric cancer surgery on elderly patients. In particular, it must be performed carefully for elderly patients with a comorbidity.
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Affiliation(s)
- Su Han Seo
- Department of Surgery, Ajou University School of Medicine, Suwon, Korea
| | - Hoon Hur
- Department of Surgery, Ajou University School of Medicine, Suwon, Korea
| | - Chang Wook An
- Department of Surgery, Ajou University School of Medicine, Suwon, Korea
| | - Xian Yi
- Department of Surgery, Ajou University School of Medicine, Suwon, Korea
| | - June Young Kim
- Department of Surgery, National Police Hospital, Seoul, Korea
| | - Sang-Uk Han
- Department of Surgery, Ajou University School of Medicine, Suwon, Korea
| | - Yong Kwan Cho
- Department of Surgery, Ajou University School of Medicine, Suwon, Korea
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23
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Gaskell S, Kristjansson SR, Audisio RA. Principles of surgical oncology in older adults. PRACTICAL GERIATRIC ONCOLOGY 2010:52-62. [DOI: 10.1017/cbo9780511763182.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/03/2025]
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24
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Hwang SH, Park DJ, Jee YS, Kim HH, Lee HJ, Yang HK, Lee KU. Risk factors for operative complications in elderly patients during laparoscopy-assisted gastrectomy. J Am Coll Surg 2008; 208:186-92. [PMID: 19228529 DOI: 10.1016/j.jamcollsurg.2008.10.023] [Citation(s) in RCA: 68] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2008] [Revised: 10/20/2008] [Accepted: 10/27/2008] [Indexed: 02/07/2023]
Abstract
BACKGROUND We evaluated the feasibility of laparoscopy-assisted gastrectomy in elderly patients with gastric cancer. STUDY DESIGN We performed a retrospective analysis of 632 patients who underwent laparoscopy-assisted gastrectomy from May 2003 to December 2007 at Seoul National University Bundang Hospital. Postoperative complication rates were compared between patients older and younger than 70 years of age. RESULTS Of the 632 patients, 515 (81.5%) were younger than 70 years and 117 (18.5%) were aged 70 years or older. Significant differences in the prevalence of cardiovascular disease and hypertension were observed in patients older than 70 years (p < 0.05). Although the overall complication rates of the patients younger and older than 70 years were 12.6% and 17.9%, respectively, there was no statistically significant difference between groups (p=0.12). Multiple logistic regression analysis revealed that comorbidities with hypertension or with liver cirrhosis were the only variables that correlated independently with postoperative complications. CONCLUSIONS Complications after laparoscopy-assisted gastrectomy for patients older than 70 years of age with gastric cancer were similar to those of younger patients. But a careful approach is required when patients older than 70 years of age have hypertension or liver cirrhosis.
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Affiliation(s)
- Sun-Hwi Hwang
- Department of Surgery, Seoul National University Bundang Hospital, Gyeonggi, Korea
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25
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Lo CH, Chen JH, Wu CW, Lo SS, Hsieh MC, Lui WY. Risk factors and management of intra-abdominal infection after extended radical gastrectomy. Am J Surg 2008; 196:741-5. [PMID: 18954604 DOI: 10.1016/j.amjsurg.2007.11.031] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2007] [Revised: 11/26/2007] [Accepted: 11/26/2007] [Indexed: 10/21/2022]
Abstract
BACKGROUND This study elucidated risk factors and management for intra-abdominal infection after extended radical gastrectomy. METHODS From 1988 to 2004, 2,076 patients with gastric cancer underwent extended radical gastrectomy at Taipei Veterans General Hospital. Risk factors for intra-abdominal infection were determined by analyzing clinicopathological factors, operative procedure, combined organ resection, operative time, blood loss, and associated disease(s). Management modalities were summarized. RESULTS The overall complication rate was 18.7%. Eighty (3.9%) patients were found to have intra-abdominal infections. Age, prolonged operation time, and combined organ resection were the precipitating factors. These patients were categorized into 3 groups: intra-abdominal abscess with adequate drainage, intra-abdominal abscess without anastomotic leakage, and intra-abdominal abscess because of leakage. Adequate drainage was the primary treatment. Mortality rate was 22.5% (18), and the most common cause of mortality was intra-abdominal abscess caused by leakage. CONCLUSIONS Although expert surgical skills can minimize the incidence of intra-abdominal infection, management also requires experience and training.
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Affiliation(s)
- Chih-Hsien Lo
- Division of General Surgery, Taipei Veterans General Hospital and National Yang Ming University, No. 201, Sec. 2, Shih-Pai Road, Taipei 112, Taiwan
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26
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Butte JM, Duarte I, Crovari F, Guzmán S, Llanos O. [Gastric cancer in patients older than 75 years. Surgical treatment and long-term survival]. Cir Esp 2008; 82:341-5. [PMID: 18053503 DOI: 10.1016/s0009-739x(07)71744-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
INTRODUCTION The characteristics and results of radical gastrectomy for gastric cancer in elderly patients are controversial. Aim. To analyze the clinicopathologic characteristics and the results of gastrectomy for cancer in a group of patients > or = 75 year old. MATERIAL AND METHOD A series of 442 patients who underwent surgery for gastric cancer was divided into group A (< 75 years old) and group B (> or = 75 years old). The clinicopathologic characteristics, results of gastrectomy, and long-term survival were compared. RESULTS The mean age was 62 +/- 13 years. There were 361 patients in group A and 81 patients in group B. Tumoral location in the upper third of the stomach was more frequent in group A than in group B (36.8% vs 24.7%), while localization in the lower third of the stomach was more frequent in group B than in group A (50.6% vs 29.4%) (p < 0.05). Total gastrectomy was performed in 66% of patients in group A and in 38% of those in group B (p < 0.05); 27.3 +/- 3.5 nodes were resected in group A and 19.5 +/- 0.7 in group B (p < 0.05). No differences were found in the frequency of complications (16%) or in overall operative mortality between the two groups. However, mortality in total gastrectomy was higher in group B (6.4%) than in group A (3.8%) (p < 0.05). No differences in 5-year survival were found between the two groups (44.3% in group A and 44.4% in group B). CONCLUSIONS In patients aged more than 75 years old, tumors were more frequently located in the distal third of the stomach. Age above 75 years does not seem to be a prognostic factor and long-term results depend more on disease stage.
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Affiliation(s)
- Jean M Butte
- Departamento de Cirugía Digestiva, División de Cirugía, Facultad de Medicina, Pontificia Universidad Católica de Chile, Santiago, Chile.
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Sato M, Yoshihara A, Miyazaki H. Preliminary study on the effect of oral care on recovery from surgery in elderly patients. J Oral Rehabil 2007; 33:820-6. [PMID: 17002741 DOI: 10.1111/j.1365-2842.2006.01634.x] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
This study aimed to clarify the effectiveness of post-operative oral care, including tooth brushing, denture cleaning and tongue cleaning, after digestive tract surgery. Subjects included 30 elderly patients aged 60-98 years (74.9 +/- 7.8 years) who underwent digestive tract surgery. Subjects were randomly divided into an intervention group and a control group. In the intervention group, the following oral care was provided daily over a 5-min period in the morning starting at baseline (day of surgery) and continued for 5 days: gargling with povidone iodine, tooth brushing, denture cleaning using a special brush and tongue cleaning using a tongue brush. In the control group, the subjects only gargled with povidone iodine. We compared the following variables between the two groups at baseline and 5 days later: the sensation of dry mouth, intra-oral gas concentration, pulmonary sounds, body temperature and bacterial flora. The number of patients with abnormal pulmonary sounds (dry or moist rales) increased from 1 to 2 in the intervention group and from 0 to 4 in the control group (P < 0.05). The average number of bacterial species per subject for the control group was 3.64 +/- 1.34 pre-operatively and 3.50 +/- 1.74 post-operatively, whereas that for the intervention group was 3.08 +/- 0.95 pre-operatively and 2.62 +/- 0.65 post-operatively. In the intervention group, there was a significant decrease in the number of bacterial species (P < 0.05). These findings indicate that post-operative oral care in elderly patients undergoing digestive tract surgery lowers the number of bacterial species found in the oral cavity. This effect, in turn, might improve respiratory function.
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Affiliation(s)
- M Sato
- Division of Preventive Dentistry, Department of Oral Health Science, Graduate School of Medical and Dental Sciences, Niigata University, Niigata, Japan
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Sjödahl K, Lu Y, Nilsen TIL, Ye W, Hveem K, Vatten L, Lagergren J. Smoking and alcohol drinking in relation to risk of gastric cancer: a population-based, prospective cohort study. Int J Cancer 2007; 120:128-132. [PMID: 17036324 DOI: 10.1002/ijc.22157] [Citation(s) in RCA: 86] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
The relations between tobacco, alcohol and risk of gastric cancer need to be established, and any gain from preventive measures should be estimated. We conducted a population-based, prospective cohort study in Nord-Trondelag county in Norway. During 1984-1986, adult residents were invited to a health survey and they answered questionnaires that assessed exposure to tobacco and alcohol, together with potential confounding factors. The exposure assessment regarding alcohol was limited to a 14-day period. New gastric cancers that occurred during follow-up (1984-2002) were identified by linkage to the Norwegian Cancer Registry. Cox proportion hazards regression models were used to calculate hazard ratios (HRs) with 95% confidence intervals (CI), adjusted for sex, education and body mass index. Follow-up of 1,117,648 person-years at risk among 69,962 cohort members revealed 251 gastric cancers, including 224 noncardia cancers. The risk was almost twice as high in daily smokers (HR = 1.88 [CI 95% = 1.33-2.67]) as in never smokers. Independent dose-response relations were found with earlier age at initiation (p = 0.02), frequency (p = 0.00) and duration of smoking (p = 0.00). Attributable risk (AR) of gastric cancer among current smokers was 8.7/100,000 person-years and the corresponding population AR was 18.4%. No statistically significant associations between various degrees of exposure to alcohol and risk of gastric cancer was revealed, but combined high use of cigarettes (>20/day) and alcohol (>5 occasions/14 days) increased the risk of noncardia gastric cancer nearly 5-fold (HR = 4.90 [95% CI = 1.90-12.62]), compared to nonusers. It is concluded that smoking is a dose-dependent risk factor for gastric cancer. Combined high exposure to smoking and alcohol further increases the risk. Successful preventive measures could considerably reduce the incidence of gastric cancer.
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Affiliation(s)
- Krister Sjödahl
- Unit of Esophageal and Gastric Research, Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden.
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