• Meta-analysis
• Pneumonia
• Risk factors
• Stomach neoplasms
• Systematic review

• Humans
• Gastrectomy/adverse effects
• Stomach Neoplasms/surgery
• Risk Factors
• Pneumonia/epidemiology
• Pneumonia/etiology
• Postoperative Complications/epidemiology
• Postoperative Complications/etiology
• Prevalence
• Female
• Male

• 2024TG024 Fujian Province health technology plan project
• No. 3502Z20244ZD1078 Xiamen Municipal Science and Technology Project

• Complications
• Elderly
• Old
• Older
• Survival

• Humans
• Stomach Neoplasms/surgery
• Stomach Neoplasms/pathology
• Stomach Neoplasms/mortality
• Female
• Aged, 80 and over
• Gastrectomy/methods
• Gastrectomy/adverse effects
• Gastrectomy/mortality
• Gastrectomy/statistics & numerical data
• Male
• Retrospective Studies
• Endoscopic Mucosal Resection/methods
• Endoscopic Mucosal Resection/statistics & numerical data
• Treatment Outcome
• Neoplasm Staging
• Kaplan-Meier Estimate
• Survival Rate

• Gastric cancer
• Lymph node metastasis
• Prediction

• GNRI
• Prognosis
• Remnant gastric cancer

• Humans
• Gastrectomy
• Stomach Neoplasms/surgery
• Stomach Neoplasms/mortality
• Stomach Neoplasms/pathology
• Aged
• Retrospective Studies
• Female
• Male
• Prognosis
• Japan/epidemiology
• Postoperative Complications/epidemiology
• Postoperative Complications/etiology
• Aged, 80 and over
• Nutrition Assessment
• Geriatric Assessment/methods
• Treatment Outcome
• Survival Rate
• Risk
• Gastric Stump/pathology
• Predictive Value of Tests
• Risk Assessment/methods

• Postoperative complications
• Radical gastrectomy
• Risk factors
• Survival outcomes

• Humans
• Stomach Neoplasms/surgery
• Stomach Neoplasms/mortality
• Stomach Neoplasms/pathology
• Gastrectomy/adverse effects
• Gastrectomy/mortality
• Male
• Female
• Postoperative Complications/etiology
• Postoperative Complications/epidemiology
• Postoperative Complications/mortality
• Middle Aged
• Aged
• Risk Factors
• Retrospective Studies
• Adult

• Abdominal surgery
• Cancer
• Comorbidity
• Older people
• Scoping review
• Surgical Outcomes

• Humans
• Elective Surgical Procedures/statistics & numerical data
• Elective Surgical Procedures/methods
• Comorbidity
• Aged
• Neoplasms/surgery
• Neoplasms/epidemiology
• Postoperative Complications/epidemiology
• Abdomen/surgery

• frailty
• gastrectomy
• gastric cancer
• laparoscopy
• postoperative complications

• Elderly patients
• Gastric cancer
• Geriatric assessment
• Preoperative support

• Humans
• Stomach Neoplasms/surgery
• Stomach Neoplasms/pathology
• Female
• Male
• Retrospective Studies
• Aged
• Postoperative Complications/epidemiology
• Preoperative Care/methods
• Aged, 80 and over
• Gastrectomy/methods
• Gastrectomy/adverse effects
• Prognosis
• Geriatric Assessment/methods
• Follow-Up Studies
• Sarcopenia/epidemiology
• Sarcopenia/complications
• Case-Control Studies
• Frailty/complications
• Frailty/epidemiology

• C-reactive protein to albumin ratio
• complication
• elderly patients
• gastric cancer
• inflammation
• nutrition
• prognostic factor

• Asian
• Gastrectomy
• Gastric cancer
• Racial disparities
• Surgical complications

• Humans
• Stomach Neoplasms
• Adenocarcinoma/pathology
• Length of Stay
• Comorbidity
• Postoperative Complications/etiology
• Gastrectomy/adverse effects
• Retrospective Studies

• Lymph node excision
• Lymphatic metastasis
• Nomograms
• Prognosis
• Stomach neoplasms

• Eunpyeong St. Mary's Hospital, The Catholic University of Korea

• National Key Research and Development Program of China

• Curability
• Elderly
• Gastric cancer
• Laparoscopic surgery
• Safety

• Gastric cancer
• complication
• elderly
• gastrectomy
• lymph node dissection

This study aimed to investigate cancer-specific survival (CSS) and associated risk factors in elderly gastric cancer (EGC) patients.

EGC patients (≥ 70 yrs) who underwent curative gastrectomy between January 2013 and December 2017 at our hospital were included. Clinicopathologic characteristics and survival data were collected. Receiver operating characteristic (ROC) analysis was used to extract the best cutoff point for body mass index (BMI). A Cox proportional hazards model was used to determine the risk factors for CSS.

In total, 290 EGC patients were included, with a median age of 74.7 yrs. The median follow-up time was 31 (1–77) mon. The postoperative 1-yr, 3-yr and 5-yr CSS rates were 93.7%, 75.9% and 65.1%, respectively. Univariate analysis revealed risk factors for CSS, including age (hazard ratio [HR] = 1.08; 95% confidence interval [CI], 1.01–1.15), intensive care unit (ICU) admission (HR = 1.73; 95% CI, 1.08–2.79), nutritional risk screening (NRS 2002) score ≥ 5 (HR = 2.33; 95% CI, 1.49–3.75), and preoperative prognostic nutrition index score < 45 (HR = 2.06; 95% CI, 1.27–3.33). The ROC curve showed that the best BMI cutoff value was 20.6 kg/m². Multivariate analysis indicated that a BMI ≤ 20.6 kg/m² (HR = 2.30; 95% CI, 1.36–3.87), ICU admission (HR = 1.97; 95% CI, 1.17–3.30) and TNM stage (stage II: HR = 5.56; 95% CI, 1.59–19.43; stage III: HR = 16.20; 95% CI, 4.99–52.59) were significantly associated with CSS.

Low BMI (≤ 20.6 kg/m²), ICU admission and advanced pathological TNM stages (II and III) are independent risk factors for CSS in EGC patients after curative gastrectomy. Nutrition support, better perioperative management and early diagnosis would be helpful for better survival.

The study aimed to investigate how elderly gastric cancer patients do postoperatively in terms of quality of life (QoL) compared to younger patients. We also investigated how the QoL of elderly gastric cancer patients has changed over the last decade in the aging population.

We included 113 elderly (≥70 years) and 202 younger patients, who underwent distal gastrectomy for stage I gastric cancer during the 2010s. The European Organisation for Research and Treatment of Cancer quality of life questionnaires were used to assess preoperative and postoperative (3-month/1-year) QoL. The baseline QoL and postoperative QoL changes were compared. The elderly patients were further grouped into the early- and late-2010s groups, based on the year of surgery, and their QoL and clinical data were compared.

The baseline QoL was significantly different on some scales (physical/role functionings, and pain/dyspnea/dysphagia) in favor of younger patients. The postoperative QoL changes were not different with the exception of emotional functioning (1-year postoperatively) in favor of younger patients. Compared to the early-2010s group, comorbidities were more frequent, and the proportion of stage IA cancer was higher in the late-2010s group. There were no QoL differences with the exception of insomnia and financial difficulties (3-months postoperatively) in favor of the late-2010s group.

Despite baseline QoL differences, elderly gastric cancer patients did as well as younger patients in terms of postoperative QoL changes. More elderly gastric cancer patients with comorbidities are undergoing gastrectomies nowadays and it does not cause them a significant QoL disadvantage.

As the elderly population increases, the number of patients with gastric cancer has also been increasing. Elderly people have various preoperative problems such as malnutrition, high frequency of comorbidities, decreased performance status, and dementia. Furthermore, when surgery is performed, high postoperative complication rates and death from other diseases are also concerns. The goal of surgery in the elderly is that short-term outcomes are comparable to those in nonelderly, and long-term outcomes reach life expectancy. Perioperative problems in the elderly include: (1) Poor perioperative nutritional status; (2) Postoperative pneumonia; and (3) Psychological problems (dementia and postoperative delirium). Malnutrition in the elderly has been reported to be associated with increased postoperative complications and dementia, pointing out the importance of nutritional management. In addition, multidisciplinary team efforts, including perioperative respiratory rehabilitation, preoperative oral care, and early postoperative mobilization programs, are effective in preventing postoperative pneumonia. Furthermore, there are many reports on the usefulness of laparoscopic surgery for the elderly, and we considered that minimally invasive surgery would be the optimal treatment after assessing preoperative risk.

• Elderly
• Gastric cancer
• Surgery
• Laparoscopy
• Gastrectomy
• Dementia

Although postoperative pulmonary infection (POI) commonly occurs in patients with esophageal cancer after curative surgery, a patient-specific predictive model is still lacking. The main aim of this study is to construct and validate a nomogram for estimating the risk of POI by investigating how perioperative features contribute to POI.

This cohort study enrolled 637 patients with esophageal cancer. Perioperative information on participants was collected to develop and validate a nomogram for predicting postoperative pulmonary infection in esophageal cancer. Predictive accuracy, discriminatory capability, and clinical usefulness were evaluated by calibration curves, concordance index (C-index), and decision curve analysis (DCA).

Multivariable logistic regression analysis indicated that length of stay, albumin, intraoperative bleeding, and perioperative blood transfusion were independent predictors of POI. The nomogram for assessing individual risk of POI indicated good predictive accuracy in the primary cohort (C-index, 0.802) and validation cohort (C-index, 0.763). Good consistency between predicted risk and observed actual risk was presented as the calibration curve. The nomogram for estimating POI of esophageal cancer had superior net benefit with a wide range of threshold probabilities (4–81%).

The present study provided a nomogram developed with perioperative features to assess the individual probability of infection may conducive to strengthen awareness of infection control and provide appropriate resources to manage patients at high risk following esophagectomy.

• Esophageal cancer
• Nomogram
• Postoperative pulmonary infection

• gastric cancer
• laparoscopic
• pneumonia

Whether the presence of postoperative complications was associated with poor prognosis of gastric carcinoma (GC) patients remain controversial. This meta-analysis was designed and reported to compare the survival difference between patients with complications and non-complications.

Cochrane Library, PubMed and Embase databases were comprehensively searched for published literatures to review current evidence on this topic. The survival data were extracted, and a random-effect or fixed-effect model was used to analyze the correlation between postoperative complications and oncologic outcome of GC patients.

Of all studies identified, 32 were eligible for this pooled analysis, with a total of 32,067 GC patients. The incidence of postoperative complications was approximately 12.5% to 51.0%. Among them, infectious complications varied from 3.0% to 28.6%, anastomotic leakage varied from 1.1% to 8.7% and postoperative pneumonia varied from 1.6% to 12.8%. The presence of postoperative complications resulted in a significant poorer overall survival (OS) of gastric carcinoma patients (hazard ratio [HR]:1.49, 95% confidence interval [CI]: 1.33-1.67, P < 0.001). Additionally, the pooled results showed a significant correlation between infectious complications and decreased OS (HR: 1.61, 95%CI: 1.38-1.88, P < 0.001). Concerning specific postoperative complications, we found that both anastomotic leakage (HR: 2.36, 95%CI: 1.62-3.42, P < 0.001) and postoperative pneumonia (HR: 1.74, 95%CI: 1.22-2.49, P = 0.002) impaired the OS of gastric carcinoma patients.

Postoperative complications were significantly correlated to recurrence and poor survival in gastric carcinoma patients. To gain a better surgical outcome and long-term oncological outcome, postoperative complications should be minimized as much as possible.

• anastomotic leakage
• gastric carcinoma
• postoperative complications
• postoperative pneumonia
• prognosis
• survival

The number of elderly patients with gastric cancer has been increasing. Most elderly patients have associated reduced physiologic functions that can sometimes become an obstacle to safe surgical treatment. The National Clinical Database Risk Calculator, which based on a large Japanese surgical database, provides predicted mortality and morbidity in each case as the surgical-related risks. The purpose of this study was to investigate the clinical significance of the risk for operative mortality (NRC-mortality), as calculated by the National Clinical Database Risk Calculator, during long-term follow-up after gastrectomy for elderly patients with gastric cancer.

We enrolled 73 patients aged ≥ 80 years and underwent gastrectomy at our institution. Their surgical risk was evaluated based on the NRC-mortality. Several clinicopathologic factors, including NRC-mortality, were selected and analyzed as the possible prognostic factors for elderly patients who have undergone gastrectomy for gastric cancer. Statistical analysis was performed using the log-rank test and Cox proportional hazard model.

NRC-mortality ranged from 0.5 to 10.6%, and the median value was 1.7%. Dividing the patients according to mortality, the overall survival was significantly worse in the high mortality group (≥ 1.7%, n = 38) than in the low mortality group (< 1.7%, n = 35), whereas disease-specific survival was not different between the two groups. In the Cox proportional hazard model, multivariate analysis revealed NRC-mortality, performance status, and surgical procedure as the independent prognostic factors for overall survival. For disease-specific survival, the independent prognostic factors were performance status and pathological stage but not NRC-mortality.

The NRC-mortality might be clinically useful for predicting both surgical mortality and overall survival after gastrectomy in elderly patients with gastric cancer.

• Elderly
• Gastric cancer
• Overall survival
• Prognosis
• Risk calculator

• elderly patient
• gastrectomy
• gastric cancer
• laparoscopy

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.

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.

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.

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.

• complications
• elderly
• gastric cancer
• risk factors
• weight loss

• Aged 80
• Elderly
• Surgery

• Aged, 80 and over
• Colorectal Neoplasms/surgery
• Digestive System Neoplasms/surgery
• Esophageal Neoplasms/surgery
• Humans
• Liver Neoplasms/surgery
• Pancreatic Neoplasms/surgery
• Postoperative Complications/epidemiology
• Postoperative Complications/mortality
• Stomach Neoplasms/surgery
• Surgical Oncology

• Gastric cancer
• Multivisceral resection
• Postoperative complications
• Prognostic score
• Recurrence

• Adult
• Aged
• Aged, 80 and over
• Brazil/epidemiology
• Female
• Follow-Up Studies
• Gastrectomy/adverse effects
• Humans
• Incidence
• Male
• Middle Aged
• Neoplasm Recurrence, Local/epidemiology
• Neoplasm Staging
• Postoperative Complications/epidemiology
• Prognosis
• Prospective Studies
• Risk Assessment/methods
• Stomach Neoplasms/surgery

• Gastric cancer
• Pneumonia
• Predictor
• Systemic inflammation score

• Enhanced recovery after surgery
• Health-related quality of life
• Lung cancer surgery
• Multicenter randomized controlled trial
• Post-operative complication incidence
• Pulmonary function
• Pulmonary rehabilitation

• China
• Humans
• Incidence
• Lung/physiopathology
• Lung Neoplasms/rehabilitation
• Lung Neoplasms/surgery
• Multicenter Studies as Topic
• Postoperative Complications/epidemiology
• Pragmatic Clinical Trials as Topic
• Quality of Life
• Risk Factors
• Treatment Outcome

• Elderly
• Gastric cancer
• Surgery
• Survival
• Very old

• Adenocarcinoma/mortality
• Adenocarcinoma/surgery
• Aged
• Aged, 80 and over
• Female
• Gastrectomy/mortality
• Hospital Mortality
• Humans
• Male
• Retrospective Studies
• Stomach Neoplasms/mortality
• Stomach Neoplasms/surgery

• Elderly
• gastrectomy
• gastric cancer

• Aged, 80 and over
• Female
• Follow-Up Studies
• Frailty/physiopathology
• Gastrectomy/mortality
• Humans
• Laparoscopy/mortality
• Male
• Morbidity
• Postoperative Complications
• Prognosis
• Prospective Studies
• Retrospective Studies
• Risk Factors
• Stomach Neoplasms/mortality
• Stomach Neoplasms/pathology
• Stomach Neoplasms/surgery
• Survival Rate

The aim of this retrospective study was to develop and validate a nomogram for predicting the risk of post-operative pulmonary infection (POI) in gastric cancer (GC) patients following radical gastrectomy. 2469 GC patients who underwent radical gastrectomy were enrolled, and randomly divided into the development and validation groups. The nomogram was constructed based on prognostic factors using logistic regression analysis, and was internally and crossly validated by bootstrap resampling and the validation dataset, respectively. Concordance index (C-index) value and calibration curve were used for estimating the predictive accuracy and discriminatory capability. Sixty-five (2.63%) patients developed POI within 30 days following surgery, with higher rates of requiring intensive care and longer post-operative hospital stays. The nomogram showed that open operation, chronic obstructive pulmonary disease (COPD), intra-operative blood transfusion, tumor located at upper and/or middle third and longer operation time (≥4 h) in a descending order were significant contributors to POI risk. The C-index value for the model was 0.756 (95% CI: 0.675−0.837), and calibration curves showed good agreement between nomogram predictions and actual observations. In conclusion, a nomogram based on these factors could accurately and simply provide a picture tool to predict the incidence of POI in GC patients undergoing radical gastrectomy.

•

Immune thrombocytopenic purpura (ITP) is an autoimmune disease characterized by thrombocytopenia.

Immune thrombocytopenic purpura is an acquired thrombocytopenia. Preoperative management of thrombocytopenia is important in patients with gastric cancer. Partial splenic embolization can be effective for patients with thrombocytopenia, but could lead to ischemic necrosis of the remnant stomach when performing subtotal gastrectomy with splenectomy.

The patient is an 84-year old woman evaluated for anemia. Endoscopy revealed an advanced gastric cancer with bleeding. The patient also had immune thrombocytopenic purpura with a platelet count <50,000/μL. Administration of platelets did not increase the platelet count. Partial splenic embolization was performed followed by administration of high-dose immunoglobulin. The platelet count was over 50,000/μL preoperatively. The patient underwent combined subtotal gastrectomy and splenectomy, followed by an uneventful course.

Patients with immune thrombocytopenic purpura and advanced gastric cancer can have anemia. Partial splenic embolization has been used to treat patients with refractory immune thrombocytopenic purpura as an alternative to splenectomy. Preoperative partial splenic embolization and high-dose immunoglobulin therapy resulted an increased platelet count in this patient. Elderly patients with gastric cancer have a high risk of postoperative complications. Patients with gastric cancer undergoing total gastrectomy have an impaired postoperative quality of life compared to those who undergo subtotal gastrectomy. We performed a subtotal gastrectomy and splenectomy as a function-preserving operation, completed safely by maintaining blood flow to the remnant stomach.

Partial splenic embolization is effective for patients with immune thrombocytopenic purpura and gastric cancer. Combined subtotal gastrectomy and splenectomy is achieved by preserving blood flow to the remnant stomach.

• Case report
• Gastric cancer
• Immune thrombocytopenic purpura
• Partial splenic embolization

In gastrectomy, postoperative elevation of C-reactive protein (CRP) is thought to be useful for predicting complications. Laparoscopic gastrectomy (LG) is less invasive than laparotomy and the elevation of CRP is also mild. Postoperative complications such as anastomotic leakage not only increase the severity of the condition, but also carry a poor prognosis when treatment is delayed. Early treatment is therefore necessary.

This retrospective study examined the relationship between occurrence of complications and the ratio of CRP levels on postoperative days 1 and 3 (CRP ratio) for 449 gastric cancer patients who underwent LG in the Department of Gastrointestinal Surgery at Osaka City University Hospital between 2006 and 2016.

We observed that factors associated with postoperative complications were preoperative renal failure and CRP ratio. No significant associations with surgical procedure, operation time, bleeding volume, age, obesity, measured CRP concentration, or white blood cell count were evident. The optimal cut-off for CRP ratio to predict postoperative complications from the receiver operating characteristic curve was 2.13.

Our results suggested that the risk of severe postoperative complications after LG could be predicted using the CRP ratio.

• C-reactive protein
• Gastric cancer
• Laparoscopic gastrectomy
• Postoperative complication

• Elderly
• Frail
• Lymph node excision
• Postoperative complications
• Stomach neoplasms

• Adenocarcinoma/diagnosis
• Adenocarcinoma/secondary
• Adenocarcinoma/surgery
• Adult
• Aged
• Aged, 80 and over
• Brazil/epidemiology
• Endoscopy, Gastrointestinal
• Female
• Follow-Up Studies
• Gastrectomy/methods
• Humans
• Lymph Node Excision/methods
• Lymph Nodes/pathology
• Lymph Nodes/surgery
• Male
• Middle Aged
• Neoplasm Staging
• Retrospective Studies
• Stomach Neoplasms/mortality
• Stomach Neoplasms/pathology
• Stomach Neoplasms/surgery
• Survival Rate/trends
• Tomography, X-Ray Computed

• Case report
• Gastric cancer
• Immune thrombocytopenia
• Surgical treatment