J Gastric Cancer.  2018 Sep;18(3):253-263. 10.5230/jgc.2018.18.e27.

Impact of Various Types of Comorbidities on the Outcomes of Laparoscopic Total Gastrectomy in Patients with Gastric Carcinoma

• Jeong O
• Jung MR
• Ryu SY

• KMID: 2420785
• DOI: http://doi.org/10.5230/jgc.2018.18.e27

Abstract

PURPOSE
With increasing life expectancy, the presence of comorbidities has become a major concern in elderly patients who require surgery. However, little is known about the impact of different comorbidities on the outcomes of laparoscopic total gastrectomy (LTG). In this study, we investigated the impact of comorbidities on postoperative complications in patients undergoing LTG for gastric carcinoma.
MATERIALS AND METHODS
We retrospectively reviewed the cases of 303 consecutive patients who underwent LTG for gastric carcinoma between 2005 and 2016. The associations between each comorbidity and postoperative complications were assessed using univariate and multivariate analyses.
RESULTS
A total of 189 patients (62.4%) had one or more comorbidities. Hypertension was the most common comorbidity (37.0%), followed by diabetes mellitus (17.8%), chronic viral hepatitis (2.6%), liver cirrhosis (2.6%), and pulmonary (27.1%), ischemic heart (3.3%), and cerebrovascular diseases (2.3%). The overall postoperative morbidity and mortality rates were 20.1% and 1.0%, respectively. Patients with pulmonary disease significantly showed higher complication rates than those without comorbidities (32.9% vs. 14.9%, respectively, P=0.003); patient with other comorbidities showed no significant difference in the incidence of LTG-related complications. During univariate and multivariate analyses, pulmonary disease was found to be an independent predictive factor for postoperative complications (odds ratio, 2.14; 95% confidence interval, 1.03-4.64), along with old age and intraoperative bleeding.
CONCLUSIONS
Among the various comorbidities investigated, patients with pulmonary disease had a significantly higher risk of postoperative complications after LTG. Proper perioperative care for optimizing pulmonary function may be required for patients with pulmonary disease.

Keyword

Stomach neoplasms; Comorbidity; Postoperative complications; Laparoscopy; Gastrectomy

MeSH Terms

Aged
Cerebrovascular Disorders
Comorbidity*
Diabetes Mellitus
Gastrectomy*
Heart
Hemorrhage
Hepatitis
Humans
Hypertension
Incidence
Laparoscopy
Life Expectancy
Liver Cirrhosis
Lung Diseases
Mortality
Multivariate Analysis
Perioperative Care
Postoperative Complications
Retrospective Studies
Stomach Neoplasms

Figure

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  Fig. 1 Incidence of postoperative complications, according to the number of comorbidities.

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  Fig. 2 Postoperative complication rate in various types of comorbidities. *Statistically significant difference compared to patients without comorbidities.

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