术后并发症对胃癌生存的影响

Impact of postoperative complications on gastric cancer survival

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SURGERY

影响因子:2.7

分区:医学2区 / 外科2区

发表日期:2025 Feb

作者: Ayato Obana, Kenichi Iwasaki, Tatsushi Suwa

DOI: 10.1016/j.surg.2024.09.031

摘要

术后并发症的长期影响，尤其是在胃切除术后非癌症相关死亡方面，仍不明确。我们旨在评估这些并发症对非癌症相关死亡的影响。本研究队列包括在日本一家医院接受根治性胃切除术的236例胃癌患者，按Clavien-Dindo分级≥II的并发症与否进行分组。采用Kaplan-Meier法、log-rank检验和Cox风险比分析，评估无复发生存率和总生存率，并识别并发症和生存预测因素。精神状态混乱（谵妄）是最常见的并发症（52例中的21例）。观察到总生存率存在显著差异（有并发症者：3年58.1%、5年51.6%；无并发症者：3年82.3%、5年73.6%；P<0.001），而无复发生存率差异不显著（有并发症者：3年77.8%、5年77.8%；无并发症者：3年87.5%、5年85.2%）。非癌症相关死亡主要由于肺炎，在并发症组显著多于无并发症组。多种因素如高美国麻醉医师协会（ASA）身体状况评分、输血、开腹手术、男性、全胃切除史及神经/精神疾病史，均与总生存率降低呈独立相关。术后并发症影响患者的长期预后，导致总生存率下降和非癌症死亡增加。优化术前管理、预防并发症及术后干预，尤其是肺部疾病预防，是改善胃切除术后预后的关键策略。

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.