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Preoperative restrictive pulmonary dysfunction influences the survival after gastrectomy for elderly patients with gastric carcinoma

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Abstract

Purpose

We aimed to evaluate the prognostic impact of pulmonary dysfunctions and their relationships with other possible prognostic factors, especially sarcopenia, in elderly patients with gastric carcinoma (GC).

Methods

In total, 402 elderly GC patients (≥ 75 years) who underwent radical gastrectomy were retrospectively reviewed. Restrictive and obstructive pulmonary dysfunction were defined as %VC < 80% and FEV1.0% < 70%, respectively.

Results

Forty-two patients (10.4%) had a low %VC, which was associated with ASA-PS, comorbidity and sarcopenia while correlating with neither the FEV1.0% nor pathological variables. The overall survival in the low %VC group was significantly worse than that in the high %VC group, especially in those with pStage I/II diseases. The survival was not stratified by FEV1.0%. Non-gastric cancer-related deaths were more prevalent in the low %VC group than in the high %VC group. The cancer-specific survival showed no significant differences between the two groups. A multivariate analysis revealed a low %VC to be the most powerful predictor of a poor survival among all independent variables, including sex, age, comorbidity, total gastrectomy, and pStage. Patients with both a low %VC and sarcopenia showed an extremely poor survival.

Conclusions

Preoperative restrictive pulmonary dysfunction was independently associated with poor survival outcomes, especially when present in combination with sarcopenia, due to an increased risk of death from non-cancer-related causes.

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Abbreviations

GC:

Gastric carcinoma

VC:

Vital capacity

FEV:

Forced expiratory volume

SMI:

Skeletal muscle index

HU:

Hounsfield unit

ASA-PS:

American Society of Anesthesiologists physical status

CCI:

Charlson Comorbidity Index

C-D:

Clavien-Dindo

OS:

Overall survival

RPD:

Restrictive pulmonary disease

COPD:

Chronic obstructive pulmonary disease

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Authors and Affiliations

  1. Department of Gastrointestinal Surgery, Graduate School of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-8655, Japan

    Kotaro Sugawara, Hiroharu Yamashita, Sho Yajima, Yasuhiro Okumura, Masato Nishida, Koichi Yagi, Susumu Aikou & Yasuyuki Seto

  2. Biostatistics Division, Clinical Research Support Center, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan

    Yukari Uemura

  3. Department of Bariatric and Metabolic Care, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan

    Susumu Aikou

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  1. Kotaro Sugawara
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  2. Hiroharu Yamashita
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Contributions

SK, YH, YS and SY designed the study and wrote the initial draft of the manuscript. UY, YK and AS contributed to the analysis and interpretation of data and assisted in the preparation of the manuscript. All other authors (NM and OY) contributed to the data collection and interpretation and critically reviewed the manuscript. All authors approved the final version of the manuscript and agreed to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved.

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Correspondence to Kotaro Sugawara.

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Sugawara, K., Yamashita, H., Yajima, S. et al. Preoperative restrictive pulmonary dysfunction influences the survival after gastrectomy for elderly patients with gastric carcinoma. Surg Today 50, 1065–1073 (2020). https://doi.org/10.1007/s00595-020-01983-y

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  • DOI: https://doi.org/10.1007/s00595-020-01983-y

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