Serdar ŞENOL, Mustafa KUŞAK, Ahmet Can SARI, Mehmet Emin KARA

Altmış beş yaş ve üzeri mide kanserli hastalarda küratif gastrektomi sonrası genel komplikasyonlar için risk faktörlerinin değerlendirilmesi

Amaç: Bu çalışmanın amacı, 65 yaş ve üstü mide kanserli hastalarda postoperatif komplikasyonlar için risk faktörlerini belirlemektir. Yöntem: Veri tabanımızdaki tıbbi kayıtlardan elde edilen veriler retrospektif olarak gözden geçirildi ve analiz edildi. Kliniğimizde Ocak 2017 ile Aralık 2021 tarihleri arasında mide kanseri tanısı almış, 229 hastaya küratif gastrektomi uygulandı. Altmış beş yaşından küçük olan seksen sekiz; karın cerrahisi, multivisseral rezeksiyon, perforasyon, kanama, tıkanıklık nedeniyle acil cerrahi öyküsü olan 21; preoperatif radyoterapi veya kemoterapi uygulanmış 18 hasta çalışmadan dışlandı. Altmış beş yaş ve üzeri 102 hasta çalışmaya dahil edildi. Hasta özellikleri, intraoperatif bulgular ve postoperatif komplikasyonlar değerlendirildi. Bulgular: Yirmi dokuz hastada (%28.4) Clavien–Dindo derecesi ≥ II olan postoperatif komplikasyonlar gözlendi. Tek değişkenli analizlerde, prognostik beslenme indeksinin (<45) (olasılık oranı 0,91; %95 güven aralığı, 0,86-0,97; p = 0,004), kontrol beslenme durum skorunun (≥5) (olasılık oranı 1,27; %95 güven aralığı, 1,09-1,49; p = 0,002) ve vücut kitle indeksinin (VKİ) (≥25 kg/m2) (olasılık oranı 1,97; %95 güven aralığı, 1,00-1,26; p = 0,042) postoperatif komplikasyonları anlamlı şekilde öngördüğü belirlendi. Çok değişkenli analizlerde, VKİ'nin (≥25 kg/m2) (olasılık oranı 1,18; %95 güven aralığı, 1,03-1,34; p = 0,011) postoperatif komplikasyonları önemli ölçüde öngördüğü gösterildi. Sonuç: Küratif gastrektomi uygulanan 65 yaş ve üzeri mide kanserli bireylerde genel postoperatif komplikasyon riski, yüksek VKİ'li hastalarda anlamlı olarak daha yüksekti. Elektif küratif gastrektomi geçiren yaşlı hastalarda VKİ'ye odaklanan perioperatif yönetim önemlidir.

Anahtar Kelimeler:

Ameliyat sonrası komplikasyon, Mide kanseri, Risk faktörü, Yaşlı hastalar

An evaluation of risk factors for overall complications after curative gastrectomy in gastric cancer patients aged 65 or over

Aim: The purpose of this study was to identify risk factors for postoperative complications in patients with gastric cancer aged 65 or over. Methods: Data from medical records in our database were reviewed and analyzed retrospectively. Two hundred twenty-nine patients with histologically confirmed gastric cancer underwent curative gastrectomy in our clinic between January 2017 and December 2021. Eighty-eight patients younger than 65 and 21 with previous histories of abdominal surgery, multi-visceral resection, emergency surgery due to perforation, bleeding, or obstruction, 18 with preoperative radiotherapy or chemotherapy were excluded. The remaining 102 patients, aged 65 years or over, were included in the study. Patient characteristics, intraoperative findings, and postoperative complications were evaluated. Results: Postoperative complications with Clavien–Dindo grade ≥ II were observed in 29 patients (28.4%). Univariate analysis showed that the prognostic nutritional index (<45) (odds ratio 0.91; 95% confidence interval, 0.86-0.97; p = 0.004), controlling nutritional status score (≥5) (odds ratio 1.27; 95% confidence interval, 1.09-1.49; p = 0.002), and body mass index (BMI) (≥25 kg/m2) (odds ratio 1.97; 95% confidence interval, 1.00-1.26; p = 0.042) significantly predicted postoperative complications. Multivariate analysis showed that BMI (≥25 kg/m2) (odds ratio 1.18; 95% confidence interval, 1.03-1.34; p = 0.011) significantly predicted postoperative complications. Conclusion: The overall postoperative complication risk among older individuals with gastric cancer who underwent curative gastrectomy was significantly higher among high-BMI patients. Perioperative management with a focus on BMI is important in older patients undergoing elective curative gastrectomy.

Keywords:

Gastric cancer, Older patients, Postoperative complication, Risk factor,

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