Perioperative Management of Coexisting Diseases for Elderly Patients with Gastric Cancer_CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Authors：

FAN Tao , DAI Dongqiu , XU Huimian , DENG Peng , SONG Yingjie

*Department of Surgical Oncology, The First Affiliated Hospital of China Medical University, Shenyang 110001, China;

Corresponding author：

Keywords：

Elderly patient; Gastric carcinoma; Coexisting diseases; Perioperative period; Mortality

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Objective To explore the perioperative management of the coexisting diseases for the elderly patients with gastric cancer. Methods The clinical data of perioperative management for coexisting diseases in 528 patients with gastric cancer over 70 years old treated in the First Affiliated Hospital of China Medical University from March 1980 to November 2008 were analyzed retrospectively. Results The main coexisting diseases included cardiovascuclar disease (259 cases, 49.05%), respiratory disease (161 cases, 30.49%), diabetes (72 cases, 13.64%). Adjusting blood pressure and blood glucose, improving cardiopulmonary function, and hepatic and renal function were mainly given. The common postoperative complications included intestinal obstruction (10 cases), pneumonia (10 cases), reflux esophagitis (9 cases), functional evacuation disorder of gastric remnant (7 cases), and anastomotic leakage (5 cases). Ten patients died during perioperative period: 6 died of heart and lung failure, 2 of acute myocardial infarction, 1 of anastomotic leakage, 1 of intestinal obstruction. Conclusions The common coexisting diseases in the elderly patients with gastric cancer are hypertension， bronchitis and diabetes. Complete assessment of the patient’s general health before operation and intensive perioperative management of the coexisting diseases not only can decrease the risk of surgical procedures， but also decrease the incidence of complication and perioperative mortality.

Citation： FAN Tao,DAI Dongqiu,XU Huimian,DENG Peng,SONG Yingjie. Perioperative Management of Coexisting Diseases for Elderly Patients with Gastric Cancer. CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY, 2009, 16(12): 1017-1019,1024. doi: Copy

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10.	Howell SJ, Sear JW, Fox P. Hypertension, hypertensive heart disease and perioperative cardiac risk [J]. Br J Anaesth, 2004; 92(4): 570-583.
11.	Kanat F, Golcuk A, Teke T, et al. Risk factors for postoperative pulmonary complications in upper abdominal surgery [J]. ANZ J Surg, 2007; 77(3): 135-141.
12.	张伟, 赵高平, 杨春, 等. 胃肠道肿瘤合并糖尿病患者术后早期肠内营养支持及血糖控制 [J]. 中国普外基础与临床杂志, 2008; 15(6): 444-447.
13.	翟刚, 李强, 张计平. 老年胃癌患者围手术期治疗体会 [J]. 肿瘤研究与临床, 2003; 15(2): 115-116.
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15.	Ichikawa D, Kurioka H, Yamaguchi T, et al. Postoperative complications following gastrectomy for gastric cancer during the last decade [J]. Hepatogastroenterology, 2004; 51(56): 613-617.
16.	Kawasaki N, Suzuki Y, Nakayoshi T, et al. Early postoperative enteral nutrition is useful for recovering gastrointestinal motility and maintaining the nutritional status [J]. Surg Today, 2009; 39(3): 225-230.

1. 陈峻青, 夏志明主编. 胃肠癌手术学 [M]. 第2版. 北京：人民卫生出版社, 2008： 167.
2. Matsushita I, Hanai H, Kajimura M, et al. Should gastric cancer patients more than 80 years of age undergo surgery? Comparison with patients not treated surgically concerning prognosis and quality of life [J]. J Clin Gastroenterol, 2002; 35(1): 29-34.
3. 程爱群, 李翔, 朱捷, 等. 老年胃癌患者的外科治疗和围手术期处理 [J]. 中华胃肠外科杂志, 2004; 7(2): 130-133.
4. Walsh SR, Oates JE, Anderson JA, et al. Postoperative arrhythmias in colorectal surgical patients: incidence and clinical correlates [J]. Colorectal Dis, 2006; 8(3): 212-216.
5. 张广平, 冯笑山, 陈登庭. 高龄胃癌患者临床治疗分析 [J]. 中国肿瘤临床与康复, 2003; 10(3): 250-251.
6. 陈娟, 管向东. 合并高血压病人围手术期处理 [J]. 中国实用外科杂志, 2008; 28(2): 102-104.
7. 喻田, 余志豪. 围术期高血压的发生与处理 [J]. 中华麻醉学杂志, 2002; 22(6): 382-384.
8. Lewington S, Clarke R, Qizilbash N, et al. Age-specific relevance of usual blood pressure to vascular mortality: a meta-analysis of individual data for one million adults in 61 prospective studies [J]. Lancet, 2002; 360(9349): 1903-1913.
9. 汪静, 吴言涛. 合并原发性高血压病行腹部手术患者术前准备初探 [J]. 中国普外基础与临床杂志, 2002; 9(2): 115-117.
10. Howell SJ, Sear JW, Fox P. Hypertension, hypertensive heart disease and perioperative cardiac risk [J]. Br J Anaesth, 2004; 92(4): 570-583.
11. Kanat F, Golcuk A, Teke T, et al. Risk factors for postoperative pulmonary complications in upper abdominal surgery [J]. ANZ J Surg, 2007; 77(3): 135-141.
12. 张伟, 赵高平, 杨春, 等. 胃肠道肿瘤合并糖尿病患者术后早期肠内营养支持及血糖控制 [J]. 中国普外基础与临床杂志, 2008; 15(6): 444-447.
13. 翟刚, 李强, 张计平. 老年胃癌患者围手术期治疗体会 [J]. 肿瘤研究与临床, 2003; 15(2): 115-116.
14. Gil-Rendo A, Hernández-Lizoain JL, Martínez-Regueira F, et al. Risk factors related to operative morbidity in patients undergoing gastrectomy for gastric cance [J]. Clin Transl Oncol, 2006; 8(5): 354-361.
15. Ichikawa D, Kurioka H, Yamaguchi T, et al. Postoperative complications following gastrectomy for gastric cancer during the last decade [J]. Hepatogastroenterology, 2004; 51(56): 613-617.
16. Kawasaki N, Suzuki Y, Nakayoshi T, et al. Early postoperative enteral nutrition is useful for recovering gastrointestinal motility and maintaining the nutritional status [J]. Surg Today, 2009; 39(3): 225-230.

CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Perioperative Management of Coexisting Diseases for Elderly Patients with Gastric Cancer

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