Risk factors affecting postoperative ileus after total gastrectomy in elderly patients with gastric cancer_CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Authors：

SHI Shuai ¹ , FENG Tao ¹ , GAO Dejian1 ¹ , WU Xiaojing ¹ , WU Xi ¹ ,  ZHANG Xiangli ²

1. The Second Department of General Surgery, Shaanxi Provincial People’s Hospital, Xi’an 710068, P. R. China;
2. Critical Care Medicine Union, Shaanxi Provincial People’s Hospital, Xi’an 710068, P. R. China;

Corresponding author：

ZHANG Xiangli, Email: 304469041@qq.com

Keywords：

elderly; gastric cancer; total gastrectomy; postoperative ileus; risk factors

DOI：

10.7507/1007-9424.202306059

Video：

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Objective To analyze the risk factors affecting the postoperative ileus after total gastrectomy in elderly patients with gastric cancer. Methods The elderly patients with gastric cancer after total gastrectomy admitted to the Second Department of General Surgery of Shaanxi Provincial People’s Hospital from January 2015 to December 2020 were retrospectively collected and the postoperative ileus was analyzed. Meanwhile the risk factors affecting the postoperative ileus after total gastrectomy in the elderly patients with gastric cancer were analyzed using univariate and multivariate logtistic regression analyses. Results A total of 306 elderly patients with gastric cancer who met the inclusion and exclusion criteria of this study were collected, 33 (10.8%) of whom suffered the postoperative ileus after surgery. The results of multivariate logtistic regression analysis showed that the preoperative anemia [OR (95%CI)=2.740 (1.181, 6.356), P=0.019], preoperative complicated intestinal obstruction [OR (95%CI)=3.286 (1.208, 8.935), P=0.020], open operation [OR (95%CI)=3.753 (1.298, 10.848), P=0.015], and operative time ≥400 min [OR (95%CI)=3.902 (1.705, 8.925), P=0.001] increased the risk probability of postoperative ileus after total gastrectomy in the elderly patients with gastric cancer. Conclusions According to the analysis results of this study, the preoperative anemia and complicated intestinal obstruction, as well as the adopted open surgery and operation time ≥400 min are the risk factors of postoperative ileus in elderly patients with gastric cancer after total gastrectomy. When total gastrectomy is chosen for elderly patients with gastric cancer, preoperative physical status needs to be adjusted, such as correcting anemia and removing preoperative intestinal obstruction. During operation, the operation modus should be prior to the minimally invasive surgery according to the individual conditions of elderly patients and the operation skills of surgeons should be improved so as to reduce postoperative ileus.

Citation： SHI Shuai, FENG Tao, GAO Dejian1, WU Xiaojing, WU Xi, ZHANG Xiangli. Risk factors affecting postoperative ileus after total gastrectomy in elderly patients with gastric cancer. CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY, 2024, 31(1): 69-73. doi: 10.7507/1007-9424.202306059 Copy

1.	Geist ACB, Mottin CC, Dillenburg CF, et al. Intestinal obstruction following gastric bypass. Obes Res Clin Pract, 2021, 15(3): 291-292.
2.	Bragg D, El-Sharkawy AM, Psaltis E, et al. Postoperative ileus: recent developments in pathophysiology and management. Clin Nutr, 2015, 34(3): 367-376.
3.	Kanda M. Preoperative predictors of postoperative complications after gastric cancer resection. Surg Today, 2020, 50(1): 3-11.
4.	王宁, 崔昊, 刘贵宾, 等. 老年胃癌患者行机器人胃癌根治术后近期并发症的影响因素分析. 中华腔镜外科杂志(电子版), 2021, 14(5): 265-270.
5.	王祖凯, 林建贤, 许燕常, 等. 年龄调整的Charlson合并症指数影响腹腔镜胃癌根治术患者预后的多中心回顾性研究. 中华消化外科杂志, 2022, 21(5): 616-627.
6.	Kahl A, du Bois A, Harter P, et al. Prognostic value of the age-adjusted Charlson comorbidity index (ACCI) on short- and long-term outcome in patients with advanced primary epithelial ovarian cancer. Ann Surg Oncol, 2017, 24(12): 3692-3699.
7.	Nagata T, Adachi Y, Taniguchi A, et al. Prognostic impacts of categorized postoperative complications in surgery for gastric cancer. Asian J Surg, 2023, 46(1): 451-457.
8.	Mizutani T. Practical management of older adults with cancer: geriatric oncology in Japan. Jpn J Clin Oncol, 2022, 52(10): 1073-1081.
9.	Guerrini GP, Esposito G, Magistri P, et al. Robotic versus laparoscopic gastrectomy for gastric cancer: the largest meta-analysis. Int J Surg, 2020, 82: 210-228.
10.	Chen QY, Xie JW, Zhong Q, et al. Safety and efficacy of indocyanine green tracer-guided lymph node dissection during laparoscopic radical gastrectomy in patients with gastric cancer: a randomized clinical trial. JAMA Surg, 2020, 155(4): 300-311.
11.	宋林杰, 李松岩, 那兴邦, 等. 结肠癌术后肠梗阻影响因素分析. 腹部外科, 2017, 30(6): 471-474.
12.	Dessai SB, Fasal R, Dipin J, et al. Age-adjusted Charlson comorbidity index and 30-day morbidity in pelvic surgeries. South Asian J Cancer, 2018, 7(4): 240-243.
13.	Tian Y, Xu B, Yu G, et al. Age-adjusted Charlson comorbidity index score as predictor of prolonged postoperative ileus in patients with colorectal cancer who underwent surgical resection. Oncotarget, 2017, 8(13): 20794-20801.
14.	Fowler AJ, Ahmad T, Phull MK, et al. Meta-analysis of the association between preoperative anaemia and mortality after surgery. Br J Surg, 2015, 102(11): 1314-1324.
15.	张文明, 陆春雷, 李科军, 等. 胃癌患者术前贫血与术后并发症及预后的相关性. 现代肿瘤医学, 2021, 29(7): 1183-1187.
16.	Pozios I, Seeliger H, Lauscher JC, et al. Risk factors for upper and lower type prolonged postoperative ileus following surgery for Crohn’s disease. Int J Colorectal Dis, 2021, 36(10): 2165-2175.
17.	Roslan F, Kushairi A, Cappuyns L, et al. The impact of sham feeding with chewing gum on postoperative ileus following colorectal surgery: a meta-analysis of randomised controlled trials. J Gastrointest Surg, 2020, 24(11): 2643-2653.
18.	Venara A, Neunlist M, Slim K, et al. Postoperative ileus: pathophysiology, incidence, and prevention. J Visc Surg, 2016, 153(6): 439-446.
19.	柳冉冉, 于航娜, 董蓓, 等. 腹腔镜治疗结直肠癌老年患者术后肠梗阻发生率及影响因素研究. 实用癌症杂志, 2021, 36(1): 112-115.
20.	Huang DD, Zhuang CL, Wang SL, et al. Prediction of prolonged postoperative ileus after radical gastrectomy for gastric cancer: a scoring system obtained from a prospective study. Medicine (Baltimore), 2015, 94(51): e2242.
21.	Docsa T, Sipos A, Cox CS, et al. The role of inflammatory mediators in the development of gastrointestinal motility disorders. Int J Mol Sci, 2022, 23(13): 6917.
22.	4Sammut R, Trapani J, Deguara J, et al. The effect of gum chewing on postoperative ileus in open colorectal surgery patients: a review. J Perioper Pract, 2021, 31(4): 132-139.
23.	Cullinan DR, Schill MR, DeClue A, et al. Fundamentals of laparoscopic surgery: not only for senior residents. J Surg Educ, 2017, 74(6): e51-e54.
24.	Wormser C, Runge JJ. Advances in laparoscopic surgery. Vet Clin North Am Small Anim Pract, 2016, 46(1): 63-84.
25.	Xiong JJ, Nunes QM, Huang W, et al. Laparoscopic vs open total gastrectomy for gastric cancer: a meta-analysis. World J Gastroenterol, 2013, 19(44): 8114-8132.

1. Geist ACB, Mottin CC, Dillenburg CF, et al. Intestinal obstruction following gastric bypass. Obes Res Clin Pract, 2021, 15(3): 291-292.
2. Bragg D, El-Sharkawy AM, Psaltis E, et al. Postoperative ileus: recent developments in pathophysiology and management. Clin Nutr, 2015, 34(3): 367-376.
3. Kanda M. Preoperative predictors of postoperative complications after gastric cancer resection. Surg Today, 2020, 50(1): 3-11.
4. 王宁, 崔昊, 刘贵宾, 等. 老年胃癌患者行机器人胃癌根治术后近期并发症的影响因素分析. 中华腔镜外科杂志(电子版), 2021, 14(5): 265-270.
5. 王祖凯, 林建贤, 许燕常, 等. 年龄调整的Charlson合并症指数影响腹腔镜胃癌根治术患者预后的多中心回顾性研究. 中华消化外科杂志, 2022, 21(5): 616-627.
6. Kahl A, du Bois A, Harter P, et al. Prognostic value of the age-adjusted Charlson comorbidity index (ACCI) on short- and long-term outcome in patients with advanced primary epithelial ovarian cancer. Ann Surg Oncol, 2017, 24(12): 3692-3699.
7. Nagata T, Adachi Y, Taniguchi A, et al. Prognostic impacts of categorized postoperative complications in surgery for gastric cancer. Asian J Surg, 2023, 46(1): 451-457.
8. Mizutani T. Practical management of older adults with cancer: geriatric oncology in Japan. Jpn J Clin Oncol, 2022, 52(10): 1073-1081.
9. Guerrini GP, Esposito G, Magistri P, et al. Robotic versus laparoscopic gastrectomy for gastric cancer: the largest meta-analysis. Int J Surg, 2020, 82: 210-228.
10. Chen QY, Xie JW, Zhong Q, et al. Safety and efficacy of indocyanine green tracer-guided lymph node dissection during laparoscopic radical gastrectomy in patients with gastric cancer: a randomized clinical trial. JAMA Surg, 2020, 155(4): 300-311.
11. 宋林杰, 李松岩, 那兴邦, 等. 结肠癌术后肠梗阻影响因素分析. 腹部外科, 2017, 30(6): 471-474.
12. Dessai SB, Fasal R, Dipin J, et al. Age-adjusted Charlson comorbidity index and 30-day morbidity in pelvic surgeries. South Asian J Cancer, 2018, 7(4): 240-243.
13. Tian Y, Xu B, Yu G, et al. Age-adjusted Charlson comorbidity index score as predictor of prolonged postoperative ileus in patients with colorectal cancer who underwent surgical resection. Oncotarget, 2017, 8(13): 20794-20801.
14. Fowler AJ, Ahmad T, Phull MK, et al. Meta-analysis of the association between preoperative anaemia and mortality after surgery. Br J Surg, 2015, 102(11): 1314-1324.
15. 张文明, 陆春雷, 李科军, 等. 胃癌患者术前贫血与术后并发症及预后的相关性. 现代肿瘤医学, 2021, 29(7): 1183-1187.
16. Pozios I, Seeliger H, Lauscher JC, et al. Risk factors for upper and lower type prolonged postoperative ileus following surgery for Crohn’s disease. Int J Colorectal Dis, 2021, 36(10): 2165-2175.
17. Roslan F, Kushairi A, Cappuyns L, et al. The impact of sham feeding with chewing gum on postoperative ileus following colorectal surgery: a meta-analysis of randomised controlled trials. J Gastrointest Surg, 2020, 24(11): 2643-2653.
18. Venara A, Neunlist M, Slim K, et al. Postoperative ileus: pathophysiology, incidence, and prevention. J Visc Surg, 2016, 153(6): 439-446.
19. 柳冉冉, 于航娜, 董蓓, 等. 腹腔镜治疗结直肠癌老年患者术后肠梗阻发生率及影响因素研究. 实用癌症杂志, 2021, 36(1): 112-115.
20. Huang DD, Zhuang CL, Wang SL, et al. Prediction of prolonged postoperative ileus after radical gastrectomy for gastric cancer: a scoring system obtained from a prospective study. Medicine (Baltimore), 2015, 94(51): e2242.
21. Docsa T, Sipos A, Cox CS, et al. The role of inflammatory mediators in the development of gastrointestinal motility disorders. Int J Mol Sci, 2022, 23(13): 6917.
22. 4Sammut R, Trapani J, Deguara J, et al. The effect of gum chewing on postoperative ileus in open colorectal surgery patients: a review. J Perioper Pract, 2021, 31(4): 132-139.
23. Cullinan DR, Schill MR, DeClue A, et al. Fundamentals of laparoscopic surgery: not only for senior residents. J Surg Educ, 2017, 74(6): e51-e54.
24. Wormser C, Runge JJ. Advances in laparoscopic surgery. Vet Clin North Am Small Anim Pract, 2016, 46(1): 63-84.
25. Xiong JJ, Nunes QM, Huang W, et al. Laparoscopic vs open total gastrectomy for gastric cancer: a meta-analysis. World J Gastroenterol, 2013, 19(44): 8114-8132.

CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Risk factors affecting postoperative ileus after total gastrectomy in elderly patients with gastric cancer

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