Background: Elderly patients with gastric cancer (GC) are at increased risk of infectious complications following gastrectomy. A limited set of risk factors has been identified to predict complications in these patients. To improve the safety of gastrectomy in this population, we investigated the incidence of infectious complications and associated clinicopathologic, nutritional and surgical risk factors in a cohort of elderly patients with GC.
Methods: Elderly GC patients (≥ 70 years) who underwent gastrectomy between January 2013 and December 2017 in Peking Union Medical College Hospital were included in the study. Clinicopathologic data were collected retrospectively. Severity of complications was classified using the Clavien–Dindo system. Infectious complications were assessed based on clinical diagnosis of health care-associated infection as defined by the US Centers for Disease Control and Prevention. Multivariate logistic regression analyses were performed to determine the risk factors for infectious complications.
Results: Three hundred thirty-one consecutive patients were included, with a median age of 74 years (range 70– 88). The rate of surgical morbidity was 37.5% and the mortality rate was 1.2%. The incidence of infectious complications was 19.6%, with the most common infectious complication being pulmonary infection (11.5%). Preoperative weight loss ≥ 5% (odds ratio [OR] = 2.21; 95% CI, 1.15– 4.28; p = 0.018), Charlson comorbidity index score ≥ 3 (OR = 2.83; 95% CI, 1.30– 6.16; p = 0.009) and preoperative hsCRP level ≥ 10 mg/L (OR = 2.48; 95% CI, 1.14– 5.38; p = 0.022) were independently associated with infectious complications.
Conclusion: Preoperative weight loss, elevated hsCRP level and comorbidity burden can be used to predict postoperative infectious complications in elderly GC patients. It is recommended to pay more attention to the treatment of elderly GC patients with these risk factors.
Keywords: gastric cancer, elderly, complications, risk factors, weight loss
Gastric cancer (GC) is the fifth most commonly diagnosed malignancy and the third leading cause of cancer death globally.1 In China, both incidence and mortality of GC rank second among malignancies and are significantly higher in the elderly population compared to the young.2 In 2015, there were an estimated 679,100 new cases and 498,000 deaths from GC in China; more than two-thirds of cases and more than three-fourths of GC deaths were accounted for by patients over 60 years old, a group that is growing as the Chinese population ages.3
The predominant curative therapy for GC is surgery, which achieved great success thanks to advances in minimally invasive surgical techniques.4,5 However, numerous challenges are involved in managing elderly GC patients, including greater incidence of postoperative complications.6–8 Specifically, owing to a greater comorbidity burden and lower functional reserve capacity, elderly patients are more susceptible to infectious complications, such as pneumonia,9,10 which can be fatal. There is no consistent definition of “elderly” patients achieved, but several studies indicated significance of surgical outcomes in GC patients when comparing patients older than 70 years with those ≤70 years.11–14
Recent studies show that postoperative complications are associated with poor short- and long-term outcomes in GC patients, such as reduced tolerance of adjuvant therapy15 and lower disease-specific survival.16,17 Surgeons must weigh the benefits of tumor resection as a potential curative therapy against the risk of postoperative complications in elderly GC patients in light of their limited life expectancy. Elderly patients with prolonged inflammatory response and increased comorbid possibly leads to high risk of infections after surgery.16 Limited studies implied that infectious complications were over 20% in older GC patients with prolonged the length of hospitalization and delayed recovery after surgery.17–19 However, evidence focused on infectious complications after gastrectomy and associated risk factors in elderly GC patients are quite little. Accordingly, we aimed to identify risk factors of infectious complications following gastrectomy in a cohort of elderly GC patients at an academic medical center in China.
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