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

Risk factors of postoperative complication after robotic gastrectomy for elder gastric cancer patients

目的分析行机器人胃癌根治术老年胃癌患者术后近期疗效及影响因素。方法回顾性分析2016年4月至2021年4月167例于解放军总医院第一医学中心普通外科医学部行机器人胃癌根治术的老年患者临床病历资料,运用单因素及多因素分析术后30 d并发症的影响因素。结果167例患者中,49例(29.3%)出现Clavien-Dindo分级≥Ⅱ级术后并发症、14例(8.4%)出现Clavien-Dindo分级≥Ⅲa级并发症。单因素分析提示:营养风险筛查2002评分≥3分、脉管侵犯、术中出血量≥400 ml、体质量指数(body mass index,BMI)≥25 kg/m^(2)、aCCI(age-adjusted charlson comorbidity index)评分≥4分与老年胃癌患者行机器人胃癌根治术后30 d内并发症相关,差异有统计学意义(P<0.05)。多因素分析结果显示脉管侵犯、术中出血量≥400 ml、BMI≥25 kg/m^(2)、aCCI评分≥4分是老年胃癌患者机器人胃癌根治术后发生术后30 d内并发症的独立危险因素(P<0.05),营养风险筛查2002评分≥3分不是其独立相关因素(P>0.05)。结论老年胃癌患者行机器人胃癌根治术安全、可行,近期疗效确切。脉管侵犯、术中出血量≥400 ml、BMI≥25 kg/m^(2)、aCCI评分≥4分是老年胃癌患者机器人胃癌根治术后发生术后30 d内并发症的独立危险因素,应对此类患者加以重视,术前充分评估以降低并发症发生概率。

Objective To analyze the short-term outcomes and factors influencing the postoperative complications of elder patients with gastric cancer under robotic gastrectomy.Methods Clinical data of 167 elder patients undergoing robotic gastrectomy in the department of general surgery,Chinese PLA General Hospital First Medical Center between Apr.2016 and Apr.2021 were retrospectively analyzed.We used univariate and multivariate analysis to find the factors affecting the 30-days postoperative complications.Results 49 of 167 patients(29.3%)had Clavien-Dindo classification≥gradeⅡpostoperative complications.14 patients(8.4%)had Clavien-Dindo classification≥gradeⅢa complications.Univariate analysis showed that vascular invasion,intraoperative blood loss≥400 ml,NRS2002 score≥3,BMI(body mass index)≥25 kg/m^(2) and aCCI(age-adjusted charlson comorbidity index)score≥4 were associated with the 30-day postoperative complications in elderly patients with gastric cancer under robotic gastrectomy(<0.05).Multivariate analysis showed that vascular invasion,intraoperative blood loss≥400 ml,BMI≥25 kg/m^(2) and aCCI score≥4 were independent risk factors for 30-days postoperative complications in elderly patients with significant difference.Conclusions Elderly patients who accepted robotic gastrectomy are safe and feasible.The independent risk factors for 30-days postoperative complications are vascular invasion,intraoperative blood loss≥400 ml,BMI≥25 kg/m^(2) and aCCI score≥4.For patients with above risk factors,surgeons need to pay more attention to avoid complications by sufficient preoperative evaluation.