Dismal prognosis of elderly gastric cancer patients who underwent gastrectomy with American Society of Anesthesiologists (ASA) 3.
ASA
Gastric cancer
Postoperative complication
Prognosis
Journal
Langenbeck's archives of surgery
ISSN: 1435-2451
Titre abrégé: Langenbecks Arch Surg
Pays: Germany
ID NLM: 9808285
Informations de publication
Date de publication:
Dec 2022
Dec 2022
Historique:
received:
23
10
2021
accepted:
30
08
2022
pubmed:
7
9
2022
medline:
25
2
2023
entrez:
6
9
2022
Statut:
ppublish
Résumé
Although the American Society of Anesthesiologists (ASA) score of 3 is relatively common in elderly patients, there have been few debates on the indications for gastrectomy in elderly gastric cancer (GC) patients with ASA3. Therefore, this study aimed to investigate gastrectomy's clinical relevance in elderly patients with GC and ASA3. We retrospectively analyzed 228 consecutive elderly GC patients (aged ≥ 75 years) without prior treatments who underwent curative gastrectomy between 2013 and 2017. Thirty-three patients with ASA3 showed significantly poorer prognosis than those with ASA1 and 2 (p = 0.004). The multivariate Cox proportional hazards model showed that ASA3 (p = 0.021) and pStage (p = 0.007) were independent prognostic factors, respectively. Elderly GC patients with pStage III and ASA3 exhibited uniquely dismal prognosis (p < 0.001); however, several survivors were still confirmed. Postoperative complications (PCs) were only the final remnant independent prognostic factor (p = 0.020) among the 33 elderly GC patients with ASA3, where dead patients included cancer-specific and other deaths, especially pneumonia. PCs were independently associated with prognostic nutritional index (PNI) (< 42.7) in elderly GC patients, and the most frequent complication was pneumonia, which was significantly associated with ASA3 and marginally associated with PNI in a multivariate analysis. ASA3 has a dismal prognosis after curative gastrectomy in the elderly GC patients, but the number of survivors was confirmed. Curative gastrectomy is not considered contraindicated even in elderly GC with ASA3. Preoperative malnutrition is associated with PCs, which proposing preoperative nutritional intervention in the context of treatment strategy for the elderly GC patients with ASA3.
Sections du résumé
BACKGROUND
BACKGROUND
Although the American Society of Anesthesiologists (ASA) score of 3 is relatively common in elderly patients, there have been few debates on the indications for gastrectomy in elderly gastric cancer (GC) patients with ASA3. Therefore, this study aimed to investigate gastrectomy's clinical relevance in elderly patients with GC and ASA3.
METHODS
METHODS
We retrospectively analyzed 228 consecutive elderly GC patients (aged ≥ 75 years) without prior treatments who underwent curative gastrectomy between 2013 and 2017.
RESULTS
RESULTS
Thirty-three patients with ASA3 showed significantly poorer prognosis than those with ASA1 and 2 (p = 0.004). The multivariate Cox proportional hazards model showed that ASA3 (p = 0.021) and pStage (p = 0.007) were independent prognostic factors, respectively. Elderly GC patients with pStage III and ASA3 exhibited uniquely dismal prognosis (p < 0.001); however, several survivors were still confirmed. Postoperative complications (PCs) were only the final remnant independent prognostic factor (p = 0.020) among the 33 elderly GC patients with ASA3, where dead patients included cancer-specific and other deaths, especially pneumonia. PCs were independently associated with prognostic nutritional index (PNI) (< 42.7) in elderly GC patients, and the most frequent complication was pneumonia, which was significantly associated with ASA3 and marginally associated with PNI in a multivariate analysis.
CONCLUSIONS
CONCLUSIONS
ASA3 has a dismal prognosis after curative gastrectomy in the elderly GC patients, but the number of survivors was confirmed. Curative gastrectomy is not considered contraindicated even in elderly GC with ASA3. Preoperative malnutrition is associated with PCs, which proposing preoperative nutritional intervention in the context of treatment strategy for the elderly GC patients with ASA3.
Identifiants
pubmed: 36066671
doi: 10.1007/s00423-022-02672-9
pii: 10.1007/s00423-022-02672-9
doi:
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
3413-3421Informations de copyright
© 2022. The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature.
Références
Bray F, Ferlay J, Soerjomataram I, Siegel RL, Torre LA, Jemal A (2018) Global cancer statistics 2018: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries. CA Cancer J Clin 68(6):394–424. https://doi.org/10.3322/caac.21492
doi: 10.3322/caac.21492
Arai H, Ouchi Y, Toba K, Endo T, Shimokado K, Tsubota K, Matsuo S, Mori H, Yumura W, Yokode M, Rakugi H, Ohshima S (2015) Japan as the front-runner of super-aged societies: perspectives from medicine and medical care in Japan. Geriatr Gerontol Int 15(6):673–687. https://doi.org/10.1111/ggi.12450
doi: 10.1111/ggi.12450
Sakurai K, Muguruma K, Nagahara H, Kimura K, Toyokawa T, Amano R, Kubo N, Tanaka H, Ohtani H, Yashiro M, Maeda K, Ohira M, Hirakawa K (2015) The outcome of surgical treatment for elderly patients with gastric carcinoma. J Surg Oncol 111(7):848–854. https://doi.org/10.1002/jso.23896
doi: 10.1002/jso.23896
Aratani K, Sakuramoto S, Chuman M, Kasuya M, Wakata M, Miyawaki Y, Gunji H, Sato H, Okamoto K, Yamaguchi S, Otsuji E, Koyama I (2018) Laparoscopy-assisted distal gastrectomy for gastric cancer in elderly patients: surgical outcomes and prognosis. Anticancer Res 38(3):1721–1725. https://doi.org/10.21873/anticanres.12407
doi: 10.21873/anticanres.12407
Takeshita H, Ichikawa D, Komatsu S, Kubota T, Okamoto K, Shiozaki A, Fujiwara H, Otsuji E (2013) Surgical outcomes of gastrectomy for elderly patients with gastric cancer. World J Surg 37(12):2891–2898. https://doi.org/10.1007/s00268-013-2210-7
doi: 10.1007/s00268-013-2210-7
Hashimoto T, Kurokawa Y, Mikami J, Takahashi T, Miyazaki Y, Tanaka K, Makino T, Yamasaki M, Motoori M, Kimura Y, Nakajima K, Mori M, Doki Y (2019) Postoperative long-term outcomes in elderly patients with gastric cancer and risk factors for death from other diseases. World J Surg 43(11):2885–2893. https://doi.org/10.1007/s00268-019-05109-5
doi: 10.1007/s00268-019-05109-5
Mohri Y, Yasuda H, Ohi M, Tanaka K, Saigusa S, Okigami M, Shimura T, Kobayashi M, Kusunoki M (2015) Short- and long-term outcomes of laparoscopic gastrectomy in elderly patients with gastric cancer. Surg Endosc 29(6):1627–1635. https://doi.org/10.1007/s00464-014-3856-4
doi: 10.1007/s00464-014-3856-4
Saklad M (1941) Grading of patients for surgical procedures. Anesthesiol: J Am Soc Anesthesiologists 2(3):281–284
doi: 10.1097/00000542-194105000-00004
Mayhew D, Mendonca V, Murthy BVS (2019) A review of ASA physical status - historical perspectives and modern developments. Anaesthesia 74(3):373–379. https://doi.org/10.1111/anae.14569
doi: 10.1111/anae.14569
Hurwitz EE, Simon M, Vinta SR, Zehm CF, Shabot SM, Minhajuddin A, Abouleish AE (2017) Adding examples to the ASA-physical status classification improves correct assignment to patients. Anesthesiol 126(4):614–622. https://doi.org/10.1097/aln.0000000000001541
doi: 10.1097/aln.0000000000001541
Abouleish AE, Leib ML, Cohen NH (2015) ASA provides examples to each ASA physical status class. ASA Newsl 79(6):38–49
Rosa F, Tortorelli AP, Quero G, Galiandro F, Fiorillo C, Sollazzi L, Alfieri S (2019) The impact of preoperative ASA-physical status on postoperative complications and long-term survival outcomes in gastric cancer patients. Eur Rev Med Pharmacol Sci 23(17):7383–7390. https://doi.org/10.26355/eurrev_201909_18846
doi: 10.26355/eurrev_201909_18846
Fujisaki M, Shinohara T, Hanyu N, Kawano S, Tanaka Y, Watanabe A, Yanaga K (2016) Laparoscopic gastrectomy for gastric cancer in the elderly patients. Surg Endosc 30(4):1380–1387. https://doi.org/10.1007/s00464-015-4340-5
doi: 10.1007/s00464-015-4340-5
Kawamura H, Tanioka T, Tahara M, Takahashi M (2013) Postoperative complication rates and invasiveness of laparoscopy-assisted distal gastrectomy and open distal gastrectomy based on the American Society of Anesthesiologists classification system. Asian J Endosc Surg 6(3):170–176. https://doi.org/10.1111/ases.12020
doi: 10.1111/ases.12020
Mikami J, Kurokawa Y, Miyazaki Y, Takahashi T, Yamasaki M, Miyata H, Nakajima K, Takiguchi S, Mori M, Doki Y (2015) Postoperative gastrectomy outcomes in octogenarians with gastric cancer. Surg Today 45(9):1134–1138. https://doi.org/10.1007/s00595-014-1087-x
doi: 10.1007/s00595-014-1087-x
Passot G, Vaudoyer D, Messager M, Brudvik KW, Kim BJ, Mariette C, Glehen O (2016) Is extended lymphadenectomy needed for elderly patients with gastric adenocarcinoma? Ann Surg Oncol 23(8):2391–2397. https://doi.org/10.1245/s10434-016-5260-x
doi: 10.1245/s10434-016-5260-x
Suematsu H, Kunisaki C, Miyamato H, Sato K, Sato S, Tanaka Y, Yukawa N, Rino Y, Kosaka T, Akiyama H, Endo I, Masuda M (2020) Laparoscopic total gastrectomy for gastric cancer in elderly patients. In Vivo 34(5):2933–2939. https://doi.org/10.21873/invivo.12123
doi: 10.21873/invivo.12123
Huang DD, Zhou CJ, Wang SL, Mao ST, Zhou XY, Lou N, Zhang Z, Yu Z, Shen X, Zhuang CL (2017) Impact of different sarcopenia stages on the postoperative outcomes after radical gastrectomy for gastric cancer. Surg 161(3):680–693. https://doi.org/10.1016/j.surg.2016.08.030
doi: 10.1016/j.surg.2016.08.030
Im Y, Park HY, Shin S, Shin SH, Lee H, Ahn JH, Sohn I, Cho JH, Kim HK, Zo JI, Shim YM, Lee HY, Kim J (2019) Prevalence of and risk factors for pulmonary complications after curative resection in otherwise healthy elderly patients with early stage lung cancer. Respir Res 20(1):136. https://doi.org/10.1186/s12931-019-1087-x
doi: 10.1186/s12931-019-1087-x
Kikuchi H, Miyata H, Konno H, Kamiya K, Tomotaki A, Gotoh M, Wakabayashi G, Mori M (2017) Development and external validation of preoperative risk models for operative morbidities after total gastrectomy using a Japanese web-based nationwide registry. Gastric Cancer 20(6):987–997. https://doi.org/10.1007/s10120-017-0706-9
doi: 10.1007/s10120-017-0706-9
Zhang R, Dippon J, Friedel G (2019) Refined risk stratification for thoracoscopic lobectomy or segmentectomy. J Thorac Dis 11(1):222–230. https://doi.org/10.21037/jtd.2018.12.44
doi: 10.21037/jtd.2018.12.44
Park JH, Kim DH, Kim BR, Kim YW (2018) The American Society of Anesthesiologists score influences on postoperative complications and total hospital charges after laparoscopic colorectal cancer surgery. Med (Baltimore) 97(18):e0653. https://doi.org/10.1097/MD.0000000000010653
doi: 10.1097/MD.0000000000010653
Frago R, McDermott F, Campillo B, Kreisler E, Biondo S (2021) Post-operative and oncological 3-year follow-up outcomes in stage 2 colonic cancer in the emergency and elective setting: a cohort study. ANZ J Surg 91(1–2):E25–E31. https://doi.org/10.1111/ans.15876
doi: 10.1111/ans.15876
Hirahara N, Matsubara T, Fujii Y, Kaji S, Kawabata Y, Hyakudomi R, Yamamoto T, Taniura T, Tajima Y (2020) Comparison of the prognostic value of immunoinflammation-based biomarkers in patients with gastric cancer. Oncotarget 11(27):2625–2635
doi: 10.18632/oncotarget.27653
Hirahara N, Tajima Y, Fujii Y, Kaji S, Kawabata Y, Hyakudomi R, Yamamoto T, Taniura T (2021) Prediction of postoperative complications and survival after laparoscopic gastrectomy using preoperative geriatric nutritional risk index in elderly gastric cancer patients. Surg Endosc 35(3):1202–1209. https://doi.org/10.1007/s00464-020-07487-7
doi: 10.1007/s00464-020-07487-7
Kim DJ, Kim W (2018) Role of laparoscopic gastrectomy in very elderly patients with gastric cancer who have outlived the average lifespan. J Gastric Cancer 18(2):109–117. https://doi.org/10.5230/jgc.2018.18.e11
doi: 10.5230/jgc.2018.18.e11
Maisch P, Lunger L, Duwel C, Schmid SC, Horn T, Gschwend JE, Sauter A, Heck MM (2021) Outcomes of palliative cystectomy in patients with locally advanced pT4 bladder cancer. Urol Oncol. https://doi.org/10.1016/j.urolonc.2020.11.042
Sauvanet A, Mariette C, Thomas P, Lozac’h P, Segol P, Tiret E, Delpero JR, Collet D, Leborgne J, Pradère B, Bourgeon A, Triboulet JP (2005) Mortality and morbidity after resection for adenocarcinoma of the gastroesophageal junction: predictive factors. J Am Coll Surg 201(2):253–262. https://doi.org/10.1016/j.jamcollsurg.2005.02.002
doi: 10.1016/j.jamcollsurg.2005.02.002
Japanese Gastric Cancer Association (2021) Japanese gastric cancer treatment guidelines 2018 (5th edition). Gastric Cancer 24(1):1–21
Doyle DJ, Goyal A, Garmon EH (2022) American Society of Anesthesiologists classification. StatPearls Publishing, Treasure Island
Onodera T, Goseki N, Kosaki G (1984) Prognostic nutritional index in gastrointestinal surgery of malnourished cancer patients. Nihon Geka Gakkai Zasshi 85(9):1001–1005
Kiuchi J, Komatsu S, Ichikawa D, Kosuga T, Okamoto K, Konishi H, Shiozaki A, Fujiwara H, Yasuda T, Otsuji E (2016) Putative risk factors for postoperative pneumonia which affects poor prognosis in patients with gastric cancer. Int J Clin Oncol 21(5):920–926. https://doi.org/10.1007/s10147-016-0987-8
doi: 10.1007/s10147-016-0987-8
Jiang N, Deng JY, Ding XW, Ke B, Liu N, Zhang RP, Liang H (2014) Prognostic nutritional index predicts postoperative complications and long-term outcomes of gastric cancer. World J Gastroenterol 20(30):10537–10544. https://doi.org/10.3748/wjg.v20.i30.10537
doi: 10.3748/wjg.v20.i30.10537
Sugawara K, Yamashita H, Urabe M, Okumura Y, Yagi K, Aikou S, Seto Y (2020) Poor nutritional status and sarcopenia influences survival outcomes in gastric carcinoma patients undergoing radical surgery. Eur J Surg Oncol 46(10 Pt A):1963–1970. https://doi.org/10.1016/j.ejso.2020.04.044
doi: 10.1016/j.ejso.2020.04.044
Tominaga T, Nagasaki T, Akiyoshi T, Fukunaga Y, Honma S, Nagaoka T, Matsui S, Minami H, Miyanari S, Yamaguchi T, Ueno M (2020) Prognostic nutritional index and postoperative outcomes in patients with colon cancer after laparoscopic surgery. Surg Today 50(12):1633–1643. https://doi.org/10.1007/s00595-020-02050-2
doi: 10.1007/s00595-020-02050-2
Hirahara N, Tajima Y, Matsubara T, Fujii Y, Kaji S, Kawabata Y, Hyakudomi R, Yamamoto T, Uchida Y, Taniura T (2020) Systemic immune-inflammation index predicts overall survival in patients with gastric cancer: a propensity score-matched analysis. J Gastrointest Surg. https://doi.org/10.1007/s11605-020-04710-7
Tanoue K, Fukunaga S, Nagami Y, Sakai T, Maruyama H, Ominami M, Otani K, Hosomi S, Tanaka F, Taira K, Kamata N, Yamagami H, Tanigawa T, Shiba M, Watanabe T, Fujiwara Y (2019) Long-term outcome of endoscopic submucosal dissection for early gastric cancer in patients with severe comorbidities: a comparative propensity score analysis. Gastric Cancer 22(3):558–566. https://doi.org/10.1007/s10120-018-0889-8
doi: 10.1007/s10120-018-0889-8