J Gastric Cancer.  2016 Mar;16(1):43-50. 10.5230/jgc.2016.16.1.43.

Low Serum Albumin Level, Male Sex, and Total Gastrectomy Are Risk Factors of Severe Postoperative Complications in Elderly Gastric Cancer Patients

Affiliations
  • 1Department of Surgery, Hanyang University Guri Hospital, Hanyang University College of Medicine, Guri, Korea. md9650@hanyang.ac.kr

Abstract

PURPOSE
It is well known that old age is a risk factor for postoperative complications. Therefore, this study aimed to explore the risk factors for poor postoperative surgical outcomes in elderly gastric cancer patients.
MATERIALS AND METHODS
Between January 2006 and December 2015, 247 elderly gastric cancer patients who underwent curative gastrectomy were reviewed. In this study, an elderly patient was defined as a patient aged ≥65 years. All possible variables were used to explore the risk factors for poor early surgical outcomes in elderly gastric cancer patients.
RESULTS
Based on multivariate analyses of preoperative risk factors, preoperative low serum albumin level (<3.5 g/dl) and male sex showed statistical significance in predicting severe postoperative complications. Additionally, in an analysis of surgery-related risk factors, total gastrectomy was a risk factor for severe postoperative complications.
CONCLUSIONS
Our study findings suggest that low serum albumin level, male sex, and total gastrectomy could be risk factors of severe postoperative complications in elderly gastric cancer patients. Therefore, surgeons should work carefully in cases of elderly gastric cancer patients with low preoperative serum albumin level and male sex. We believe that efforts should be made to avoid total gastrectomy in elderly gastric cancer patients.

Keyword

Stomach neoplasms; Aged; Risk factors; Postoperative complications

MeSH Terms

Aged*
Gastrectomy*
Humans
Male*
Multivariate Analysis
Postoperative Complications*
Risk Factors*
Serum Albumin*
Stomach Neoplasms*
Serum Albumin

Cited by  1 articles

Bioelectrical Impedance Analysis for Prediction of Early Complications after Gastrectomy in Elderly Patients with Gastric Cancer: the Phase Angle Measured Using Bioelectrical Impedance Analysis
Byunghyuk Yu, Ki Bum Park, Ji Yeon Park, Seung Soo Lee, Oh Kyoung Kwon, Ho Young Chung
J Gastric Cancer. 2019;19(3):278-289.    doi: 10.5230/jgc.2019.19.e22.


Reference

1. McKenna RJ Sr. Clinical aspects of cancer in the elderly. Treatment decisions, treatment choices, and follow-up. Cancer. 1994; 74:7 Suppl. 2107–2117.
2. World Health Organization (WHO). World health statistics 2014 [Internet]. Geneva: WHO;2014. cited 2014 May. Available from: http://www.who.int/gho/publications/world_health_statistics/2014/en/.
3. Yancik R, Ries LA. Aging and cancer in America. Demographic and epidemiologic perspectives. Hematol Oncol Clin North Am. 2000; 14:17–23.
4. Balducci L, Extermann M. Management of cancer in the older person: a practical approach. Oncologist. 2000; 5:224–237.
5. Feng MA, McMillan DT, Crowell K, Muss H, Nielsen ME, Smith AB. Geriatric assessment in surgical oncology: a systematic review. J Surg Res. 2015; 193:265–272.
6. Polanczyk CA, Marcantonio E, Goldman L, Rohde LE, Orav J, Mangione CM, et al. Impact of age on perioperative complications and length of stay in patients undergoing noncardiac surgery. Ann Intern Med. 2001; 134:637–643.
7. Evers BM, Townsend CM Jr, Thompson JC. Organ physiology of aging. Surg Clin North Am. 1994; 74:23–39.
8. Salive ME. Multimorbidity in older adults. Epidemiol Rev. 2013; 35:75–83.
9. From the centers for disease control and prevention. Public health and aging: trends in aging: United States and worldwide. JAMA. 2003; 289:1371–1373.
10. Kim KI, Park KH, Koo KH, Han HS, Kim CH. Comprehensive geriatric assessment can predict postoperative morbidity and mortality in elderly patients undergoing elective surgery. Arch Gerontol Geriatr. 2013; 56:507–512.
11. Seo SH, Hur H, An CW, Yi X, Kim JY, Han SU, et al. Operative risk factors in gastric cancer surgery for elderly patients. J Gastric Cancer. 2011; 11:116–121.
12. Otsuji E, Fujiyama J, Takagi T, Ito T, Kuriu Y, Toma A, et al. Results of total gastrectomy with extended lymphadenectomy for gastric cancer in elderly patients. J Surg Oncol. 2005; 91:232–236.
13. Kitamura K, Yamaguchi T, Taniguchi H, Hagiwara A, Yamane T, Sawai K, et al. Clinicopathological characteristics of gastric cancer in the elderly. Br J Cancer. 1996; 73:798–802.
14. Gretschel S, Estevez-Schwarz L, Hunerbein M, Schneider U, Schlag PM. Gastric cancer surgery in elderly patients. World J Surg. 2006; 30:1468–1474.
15. Kunisaki C, Akiyama H, Nomura M, Matsuda G, Otsuka Y, Ono HA, et al. Comparison of surgical outcomes of gastric cancer in elderly and middle-aged patients. Am J Surg. 2006; 191:216–224.
16. Mohri Y, Yasuda H, Ohi M, Tanaka K, Saigusa S, Okigami M. Short- and long-term outcomes of laparoscopic gastrectomy in elderly patients with gastric cancer. Surg Endosc. 2015; 29:1627–1635.
17. Kunisaki C, Makino H, Takagawa R, Oshima T, Nagano Y, Ono HA, et al. Efficacy of laparoscopy-assisted distal gastrectomy for gastric cancer in the elderly. Surg Endosc. 2009; 23:377–383.
18. Statistics Korea. Korean Statistical Information Service [Internet]. Daejeon: Statistics Korea;cited 2011 May 1. Available from: http://kosis.kr/.
19. Popovic JR. 1999 National hospital discharge survey: annual summary with detailed diagnosis and procedure data. Vital Health Stat 13. 2001; 1–206.
20. Washington K. 7th edition of the AJCC cancer staging manual: stomach. Ann Surg Oncol. 2010; 17:3077–3079.
21. Jiang N, Deng JY, Ding XW, Ke B, Liu N, Zhang RP, et al. Prognostic nutritional index predicts postoperative complications and long-term outcomes of gastric cancer. World J Gastroenterol. 2014; 20:10537–10544.
22. Onodera T, Goseki N, Kosaki G. Prognostic nutritional index in gastrointestinal surgery of malnourished cancer patients. Nihon Geka Gakkai Zasshi. 1984; 85:1001–1005.
23. Strasberg SM, Linehan DC, Hawkins WG. The accordion severity grading system of surgical complications. Ann Surg. 2009; 250:177–186.
24. Kothari A, Phillips S, Bretl T, Block K, Weigel T. Components of geriatric assessments predict thoracic surgery outcomes. J Surg Res. 2011; 166:5–13.
25. Puts MT, Hardt J, Monette J, Girre V, Springall E, Alibhai SM. Use of geriatric assessment for older adults in the oncology setting: a systematic review. J Natl Cancer Inst. 2012; 104:1133–1163.
26. Hamaker ME, Jonker JM, de Rooij SE, Vos AG, Smorenburg CH, van Munster BC. Frailty screening methods for predicting outcome of a comprehensive geriatric assessment in elderly patients with cancer: a systematic review. Lancet Oncol. 2012; 13:e437–e444.
27. Wu CW, Lo SS, Shen KH, Hsieh MC, Lui WY, P'Eng FK. Surgical mortality, survival, and quality of life after resection for gastric cancer in the elderly. World J Surg. 2000; 24:465–472.
28. Kim MG, Kim HS, Kim BS, Kwon SJ. The impact of old age on surgical outcomes of totally laparoscopic gastrectomy for gastric cancer. Surg Endosc. 2013; 27:3990–3997.
29. Gibbs J, Cull W, Henderson W, Daley J, Hur K, Khuri SF. Preoperative serum albumin level as a predictor of operative mortality and morbidity: results from the National VA Surgical Risk Study. Arch Surg. 1999; 134:36–42.
30. Moghadamyeghaneh Z, Hwang G, Hanna MH, Phelan MJ, Carmichael JC, Mills SD, et al. Even modest hypoalbuminemia affects outcomes of colorectal surgery patients. Am J Surg. 2015; 210:276–284.
31. Kirchhoff P, Dincler S, Buchmann P. A multivariate analysis of potential risk factors for intra- and postoperative complications in 1316 elective laparoscopic colorectal procedures. Ann Surg. 2008; 248:259–265.
32. Lipska MA, Bissett IP, Parry BR, Merrie AE. Anastomotic leakage after lower gastrointestinal anastomosis: men are at a higher risk. ANZ J Surg. 2006; 76:579–585.
33. Sasako M. Risk factors for surgical treatment in the Dutch Gastric Cancer Trial. Br J Surg. 1997; 84:1567–1571.
34. Launois B, Cardin JL, Bardaxoglou E, Bourdonnec P, de Chateaubriant P, Buard JL, et al. Management of cancer of the stomach: total gastrectomy versus sub-total gastrectomy. Hepatogastroenterology. 1991; 38:45–52.
35. Korenaga D, Moriguchi S, Baba H, Kakeji Y, Orita H, Haraguchi M, et al. Surgery for gastric carcinoma is feasible for patients over 80 years of age. World J Surg. 1991; 15:642–647.
Full Text Links
  • JGC
Actions
Cited
CITED
export Copy
Close
Share
  • Twitter
  • Facebook
Similar articles
Copyright © 2023 by Korean Association of Medical Journal Editors. All rights reserved.     E-mail: koreamed@kamje.or.kr