Laparoscopic Gastrectomy for Gastric Cancer Patients with Chronic Obstructive Pulmonary Disease

Kim, Jong Jin; Lee, Moon Su; Lee, Ju Hee; Park, Do Joong; Lee, Hyuk Joon; Kim, Hyung Ho; Yang, Han Kwang

Abstract

PURPOSE
The aim of this study was to evaluate the safety of laparoscopic gastrectomy for gastric cancer patients with chronic obstructive pulmonary disease (COPD).
METHODS
The medical records of 863 patients who underwent gastrectomy for gastric cancer from January 2007 to December 2008 at Seoul National University Bundang Hospital were retrospectively reviewed. One hundred forty five patients with COPD were divided into the laparoscopic gastrectomy or open gastrectomy groups. The 362 patients who underwent laparoscopic gastrectomy were divided into the COPD or the non-CODP groups. Comparative analysis between each of the two groups was done.
RESULTS
Out of 145 patients with COPD, eighty seven patients (60.0%) underwent laparoscopic gastrectomy and 58 patients (40.0%) underwent open gastrectomy. Comparing the laparoscopic gastrectomy group with the open gastrectomy group, there was no significant differences in age, gender, the body mass index, the smoking history, the preoperative general condition, the operation time, the estimated blood loss and the preoperative pulmonary function tests (p>0.05). The postoperative hospital stay was longer in the open gastrectomy group than that in the laparoscopic gastrectomy group (9.1 days vs. 6.8 days, respectively, p<0.001). One patient in the laparoscopic gastrectomy group (1/87, 1.1%) had postoperative pulmonary complications and 6 patients in the open gastrectomy group (6/58, 10.3%) had pulmonary complications (p=0.017). On comparing the COPD with the non-COPD groups for the 363 patients who underwent laparoscopic gastrectomy, there were significant differences in gender, age, a history of tuberculosis, a smoking history, the American Society of Anesthesiologists (ASA) class and the cancer stage. Yet there was no significant difference of the postoperative pulmonary complications (p=1.000) between the groups.
CONCLUSION
Laparoscopic gastrectomy can be performed safety for gastric cancer patients with mild COPD and it should be considered as a primary treatment method.