术后并发症对胃癌存活的影响
Impact of postoperative complications on gastric cancer survival
影响因子:2.70000
分区:医学2区 / 外科2区
发表日期:2025 Feb
作者:
Ayato Obana, Kenichi Iwasaki, Tatsushi Suwa
摘要
术后术后术后术后术后与非癌症患者无关的死亡率的长期影响尚不清楚。我们的目的是评估这些并发症对与非癌症相关死亡的影响。一组236例在日本医院接受胃癌治愈性胃切除术的患者的同类，基于分类为Clavien-Dindo II或更高级的并发症。 Kaplan-Meier方法，对数秩检验和COX危害比分析用于评估无复发的生存和整体存活，并鉴定并发症和生存预测因子。依赖是最常见的并发症（52例患者中的21例）。在整个生存期间观察到显着差异（并发症，3年：58.1％和5年：51.6％；无并发症，3年：82.3％和5年：73.6％； P <.001），但没有复发性生存率，但并不复杂（3岁：77.8％和5年：77.8％：77.8％； 3岁； 3岁； 3岁。与非复杂性组相比，与并发症组相比，非癌症相关的死亡主要是由肺炎引起的。包括美国麻醉学家身体状况评分，血液输血，开放手术，男性，胃切除术和神经系统/精神疾病病史在内的因素，与稳定的并发症有关，影响长期预后，导致总体存活率下降并增加了非企业家的死亡率。积极的策略，包括优化术前管理，预防并发症和入院后干预措施，至关重要，重点是预防肺部疾病，以改善胃切除术后预后。
Abstract
Long-term implications of postoperative complications, particularly non-cancer-related mortality in patients with gastric cancer following gastrectomy, remain unclear. We aimed to evaluate the impact of these complications on non-cancer-related deaths.A cohort of 236 patients who underwent curative gastrectomy for gastric cancer in a Japanese hospital was divided based on complications classified as Clavien-Dindo grade II or higher. The Kaplan-Meier method, log-rank tests, and Cox hazard ratio analysis were used to evaluate recurrence-free survival and overall survival and to identify complications and survival predictors.Delirium was the most common complication (21 of 52 patients). A significant difference was observed in the overall survival (with complications, 3-year: 58.1% and 5-year: 51.6%; without complications, 3-year: 82.3% and 5-year: 73.6%; P < .001) but not in recurrence-free survival (with complications, 3-year: 77.8% and 5-year: 77.8%; without complications, 3-year: 87.5% and 5-year: 85.2%). Non-cancer-related deaths, predominantly resulting from pneumonia, were more prevalent in the complications group than in the noncomplications group. Factors, including high American Society of Anesthesiologists Physical Status scores, blood transfusion, open surgery, male sex, total gastrectomy, and a history of neurologic/psychiatric disease, were independently associated with decreased overall survival.Postoperative complications affect long-term prognosis, resulting in decreased overall survival and increased noncancer mortality. Proactive strategies, including optimizing preoperative management, preventing complications, and postdischarge interventions, are essential, with a focus on pulmonary disease prevention to improve prognosis after gastrectomy.