Preoperative malnutrition in elderly gastric cancer patients and adverse postoperative outcomes of radical gastrectomy

Malnutrition is not only a prevalent condition among the elderly but also a common comorbidity in elderly people with gastric cancer(GC).Malnutrition is closely linked to high rates of postoperative complications and poor wound healing in elderly GC patients,which may lead to a higher incidence and mor-tality rate of GC.Malnutrition decreases the physical function of elderly GC patients after surgery,severely affecting their postoperative life quality and hindering subsequent treatments.This retrospective study was conducted by Zhao et al,focusing on the clinical baseline data,postoperative complications,and hospitalization times of elderly GC patients who underwent curative gastrectomy.Additionally,the underlying causes of poor outcomes for patients were discussed.This study may provide a solid basis for the clinical treatment of elderly GC patients in the future.Therefore,malnutrition can serve as a negative prognostic factor for curative surgery in GC patients.Addressing malnutrition and its adverse effects can benefit elderly GC patients from surgical treatment.

Comparison of short-term efficacy between totally laparoscopic gastrectomy and laparoscopic assisted gastrectomy for elderly patients with gastric cancer

BACKGROUND Totally laparoscopic gastrectomy(TLG)entails both gastrectomy and gastrointestinal reconstruction under laparoscopy.Compared with laparoscopic assisted gastrectomy(LAG),TLG has been demonstrated in many studies to require a smaller surgical incision,result in a faster postoperative recovery and less pain and have comparable long-term efficacy,which has been a research hotspot in recent years.Whether TLG is equally safe and feasible for elderly patients remains unclear.AIM To compare the short-term efficacy of and quality of life(QOL)associated with TLG and LAG in elderly gastric cancer(GC)patients.METHODS The clinicopathological data of 462 elderly patients aged≥70 years who underwent LAG or TLG(including distal gastrectomy and total gastrectomy)between January 2017 and January 2022 at the Department of General Surgery,First Medical Center,Chinese PLA General Hospital were retrospectively collected.A total of 232 patients were in the LAG group,and 230 patients were in the TLG group.Basic patient information,clinicopathological characteristics,operation information and QOL data were collected to compare efficacy.Compared with those in the LAG group,intraoperative blood loss in the TLG group was significantly lower(P<0.001),and the time to first flatus and postoperative hospitalization time were significantly shorter(both P<0.001).The overall incidence of postoperative complications in the TLG group was significantly lower than that in the LAG group(P=0.01).Binary logistic regression results indicated that LAG and an operation time>220 min were independent risk factors for postoperative complications in elderly patients with GC(P<0.05).In terms of QOL,no statistically significant differences in various preoperative indicators were found between the LAG group and the LTG group(P>0.05).Compared with the laparoscopic-assisted total gastrectomy group,patients who received totally laparoscopic total gastrectomy had lower nausea and vomiting scores and higher satisfaction with their body image(P<0.05).Patients who underwent laparoscopic-assisted distal gastrectomy were more satisfied with their body image than patients in the totally laparoscopic distal gastrectomy group(P<0.05).CONCLUSION TLG is safe and feasible for elderly patients with GC and has outstanding advantages such as reducing intracorporeal blood loss,promoting postoperative recovery and improving QOL.

Study on treatment and nursing of elderly patients with gastric cancer complicated with diabetes

Objective To study and analyze the treatment and nursing of elderly patients with gastric cancer complicated with diabetes.Methods:different data were analyzed and summarized.Conclusion:the elderly patients with gastric cancer and diabetes can cooperate with the control of blood glucose during the surgical treatment,and strengthen the nursing before and after the operation.

Newly emerging standard chemotherapies for gastric cancer and clinical potential in elderly patients

With the increase in average life expectancy,the rate of occurrence of gastric cancer in elderly patients is also rising.While many clinical trials have been conducted to examine the effect of chemotherapy treatment on gastric cancer,age limits for eligible subjects have prevented the establishment of standards for chemotherapy in elderly patients with gastric cancer.As of March 2009,evidence-based standard chemotherapy regimens were established.In the Western world,debates centered on the ECF(Epirubicin/cisplatin/5FU) or DCF(Docetaxel/cisplatin/5-FU) regimens based on the phase □ randomized controlled trial at the Royal Marsden Hospital(RMH) or the V325 study,respectively.The JCOG9912 and SPIRITS trials emerged from Japan indicating attractive regimens that include S-1 for advanced gastric cancer patients.Using these active anticancer drugs,the trials that studied the eff icacy of adjuvant therapies or surgical approaches,such as the Int-116/MAGIC/ACTS-GC trials,have actually succeeded in demonstrating the benefits of adjuvant therapies in gastric cancer patients.For cases of gastric cancer in elderly patients,treatment policies should consider these studies while analyzing not only the therapeutic effects but also drug toxicity,individual general health conditions,and social factors to select treatments that emphasize quality of life.

Clinical Application and Research Progress of Accelerated Rehabilitation Surgery in Perioperative Period of Advanced Gastric Cancer in the Elderly

Enhanced recovery after surgery (ERAS) has been used in various surgical professions in recent years and is widely accepted by doctors. This concept not only helps patients speed up postoperative recovery, reduce the incidence of related complications and shorten hospital stays, but also has been proved to be effective and safe in the perioperative application of gastric cancer. This article reviews the clinical application and research progress of enhanced recovery after surgery in the perioperative period of advanced gastric cancer in the elderly.

Distal gastric tube resection with vascular preservation for gastric tube cancer:A case report and review of literature

BACKGROUND Survival rates in patients with esophageal cancer undergoing esophagectomy have improved,but the prevalence of gastric tube cancer(GTC)has also increased.Total resection of the gastric tube with lymph node dissection is considered a radical treatment,but GTC surgery is more invasive and involves a higher risk of severe complications or death,particularly in elderly patients.CASE SUMMARY We report an elderly patient with early GTC that had invaded the duodenum who was successfully treated with resection of the distal gastric tube and Roux-en-Y(R-Y)reconstruction.The tumor was a type 0-IIc lesion with ulcer scars surrounding the pyloric ring.Endoscopic submucosal resection was not indicated because the primary lesion was submucosally invasive,was undifferentiated type,surrounded the pyloric ring,and had invaded the duodenum.Resection of distal gastric tube with R-Y reconstruction was safely performed,with preservation of the right gastroepiploic artery(RGEA)and right gastric artery(RGA).CONCLUSION Distal resection of the gastric tube with preservation of the RGEA and RGA is a good treatment option for elderly patients with cT1bN0 GTC in the lower part of the gastric tube.

Laparoscopic gastrectomy for elderly gastric-cancer patients:comparisons with laparoscopic gastrectomy in non-elderly patients and open gastrectomy in the elderly

Background:The benefits of laparoscopic gastrectomy(LG)in elderly gastric-cancer patients still remain unclear.The purpose of this study was to evaluate the feasibility and safety of LG in elderly gastric-cancer patients.Methods:We retrospectively evaluated patients who underwent LG or open gastrectomy(OG)between June 2009 and July 2015 in a single high-volume center.We compared surgical,short-term,and long-termsurvival outcomes among an elderly(-70 years old)LG(ELG)group(n=114),a non-elderly(<70 years old)LG(NLG)group(n=740),and an elderly OG(EOG)group(n=383).Results:Except for extended time to first flatus,the surgical and short-term outcomes of the ELG group were similar to those of the NLG group.The ELG group revealed comparable disease-specific survival(DSS)rates to the NLG group(64.9%vs 66.2%,P=0.476),although the overall survival(OS)rate was lower(57.0%vs 65.5%,P<0.001)in the ELG group than in the NLG group.The ELG group showed longer operation time than the EOG group(236.4677.3 vs 179652.2 min,P<0.001).The ELG group had less estimated blood loss(174.0688.4 vs 209.36133.8,P=0.008)and shorter post-operative hospital stay(8.362.5 vs 9.264.5,P=0.048)than the EOG group.The severity of complications was similar between the ELG and NLG groups.Multivariate analysis confirmed that LG was not a risk factor for post-operative complications.Conclusions:LG is a feasible and safe procedure for elderly patients with acceptable short-and long-term survival outcomes.

Morbidity and mortality of elderly patients with advanced gastric cancer after laparoscopy-assisted or open distal gastrectomy:a randomized–controlled trial

Laparoscopy-assisted distal gastrectomy(LDG)combined with D2 lymphadenectomy may be safely performed in patients with advanced gastric cancer(AGC)by experienced surgeons at specialized high-volume institutions as shown in the Chinese Laparoscopic Gastrointestinal Surgery Study(CLASS)-01.However,studies focusing on the use of LDG in patients with gastric cancer older than 65 years are rare.This study was designed to investigate the morbidity and mortality of elderly patients with gastric cancer who underwent laparoscopic-assisted or open distal gastrectomy(ODG).In this prospective,randomized,open,parallel controlled trial,patients older than 65 years with tumor located at the middle or lower part of the stomach will be enrolled in this study.Patients will be randomly divided into a laparoscopic group and an open surgery group.The early post-operative complications,intra-operative complications and post-operative recovery will be compared between the two groups.This trial will provide valuable clinical evidence for the objective assessment of the feasibility,short-term safety,and potential benefits of LDG compared with ODG for gastric cancer in the elderly patients.This trial has been registered on ClinicalTrials.gov.(Identifier:NCT02246153.)in September 22,2014.

老年胃癌患者术后早期肠内营养的应用价值分析

目的探讨早期肠内营养(EEN)支持治疗在老年胃癌患者术后的应用价值。方法选取60例老年胃癌术后行EEN支持的患者作为EEN组,同期老年胃癌术后行全肠外营养(TPN)的患者40例为TPN组。比较2组患者肛门排气时间、口服进食时间、消化道症状发生率、并发症发生率、住院时间、血清蛋白、免疫球蛋白、电解质等变化情况。结果 EEN组出现肛门排气时间较TPN组显著缩短(P<0.01);EEN组消化道症状出现率高于TPN组,经对症处理后消失;EEN组术后较术前体质量下降(1.8±0.2)kg,该下降值显著低于TPN组的(2.6±0.4)kg;EEN组住院时间较TPN组也明显缩短(P<0.05)。EEN组术后总蛋白、白蛋白及免疫球蛋白IgA显著高于TPN组(P<0.01)。EEN组电解质紊乱发生率显著低于TPN组(P<0.05)。结论 EEN营养支持适用于老年胃癌切除术患者,有助于改善患者的胃肠动力,缩短住院时间,维持机体免疫功能,有助于患者恢复。但容易出现胃肠道症状,需要控制输注速度和输入量。

老年消化道恶性肿瘤患者术后肠内营养的临床护理

目的总结老年消化道恶性肿瘤患者术后肠内营养的临床护理体会。方法回顾性分析了33例接受各种消化道手术老年患者的临床资料,所有患者均在术中行空肠造瘘,术后接受肠内营养治疗。结果31例患者完成肠内营养治疗,无导管堵塞或脱出,平均输注营养液时间为(10.4±5.9)天,平均术后肛门排气时间为(42.4±15.9)小时,术后平均住院时间为(16.7±17.2)天。16例患者出现腹胀,7例出现腹泻,13例出现糖代谢严重异常。出院前患者营养指标轻度下降,无死亡病例,伤口裂开1例,感染并发症2例,非感染并发症1例(心绞痛)。2例患者因严重腹胀及腹泻中止肠内营养。结论消化道手术后肠内营养的护理应坚持无菌配液、严格管路护理、注意血糖变化和加强心理治疗。

高龄高位胃癌患者围术期的外科护理对策

目的：探讨快速康复外科护理在高龄高位胃癌患者围术期外科护理中的效果。方法选择本院2012年1月～2013年6月收治的贲门至胃体中上部癌的高龄患者120例，将其随机分为快速康复组及传统组，各60例。传统组给予传统的护理方式，快速康复组在传统护理的基础上给予快速康复护理，出院3个月内给予随访。采用SF-36量表评分对患者的生活质量进行评价。结果与传统组比较，快速康复组SF-36的生理功能、生理职能、躯体疼痛、总体健康、活力、情感职能、社会功能、精神健康评分均明显升高（P均＜0.05）。结论快速康复外科护理可促进患者围术期术后功能的恢复，明显提高其生活质量水平，临床可广泛推广应用。

老年人早期胃癌患者行内镜下黏膜剥离术的心理护理

目的:探究心理护理对老年人早期胃癌患者行内镜下黏膜剥离术的效果。方法:选取2014年10月—2016年10月行早期胃癌剥离术的老年患者58例,随机分为对照组和观察组,每组29例。对照组仅接受常规护理,观察组在常规护理的基础上增加心理护理。比较两组患者的治疗效能感和总护理满意程度。结果:观察组和对照组的治疗效能感和总护理满意度比较,差异均有统计学意义(P<0.05)。结论:内镜下黏膜剥离术的早期胃癌老年患者在常规护理的基础上给予心理护理能有效改善治疗效果。

青海高原老年人527例胃癌胃镜分析

目的 了解高海拔地区老年胃癌内镜下特点。方法 对我院内镜室自 1995年 8月～ 1998年 12月经胃镜检查及病理证实的老年胃癌进行统计分析。结果 老年胃癌检出率为 2 1.81% ( 5 2 7/2 4 16) ,高于非老年组5 .95 % (P <0 .0 1) ;男女之比为 4 .2 1∶1,老年胃癌好发部位以胃底贲门部为最多 ,组织学类型以低分化腺癌为主。结论 老年世居者胃癌检出率远远高于移居者 (P <0 .0 1) ,早期癌检出率 0 .95 %。

中老年胃癌根治术后发生胆囊炎的危险因素分析

目的分析中老年胃癌患者外科手术治疗后发生胆囊炎的危险因素,为其防治提供参考依据。方法收集沛县人民医院2012年1月至2016年6月收治并行胃癌根治术的478例≥50岁的胃癌患者的临床资料,通过单因素和多因素回归模型分析术后发生胆囊炎的危险因素。结果 478例患者中154例(32%)发生胆囊炎。多因素回归分析结果显示,患者体重指数、第8组、第12组淋巴结清扫是手术后发生胆囊炎的独立危险因素(P<0.05)。结论中老年胃癌根治术后发生胆囊炎的风险因素包括第8、12组淋巴结清扫及体重指数,术中清扫淋巴结时需精细操作,注意保留迷走神经肝胆支。

优质护理干预对胃癌患者术后胃肠功能恢复及睡眠质量的影响

目的:探讨优质护理干预对胃癌患者术后胃肠功能恢复及睡眠质量的影响。方法:选取2016年5月至2018年5月郑州大学附属洛阳中心医院肿瘤二科收治的胃癌手术患者76例,随机分为对照组和观察组,每组38例。对照组采用常规护理干预方案,观察组在此基础上行优质护理干预,观察比较2组患者恢复情况、睡眠质量和护理满意度情况。结果:与对照组比较,观察组首次排气时间、恢复饮食时间较早,住院时间较短,差异有统计学意义(P<0.05);护理3 d前观察组睡眠质量评分与对照组比较,差异无统计学意义(P>0.05),护理7 d后2组患者睡眠质量明显改善,且观察组评分较对照组低,差异有统计学意义(P<0.05);观察组护理满意度明显高于对照组,差异有统计学意义(P<0.05)。结论:在胃癌患者术后护理中,优质护理干预效果理想,利于患者胃功能恢复,并改善其睡眠质量,推荐推广。

优质护理联合饮食改善对老年胃癌患者疼痛情况及营养状况的改善效果观察

目的:探究对老年胃癌患者实施优质护理联合饮食改善的方式对患者疼痛情况及营养状况的改善效果。方法:2018年6月-2019年12月收治胃癌患者76例,按照入院先后顺序分为两组。对照组给予常规护理干预;观察组给予优质护理联合饮食改善。比较两组患者疼痛情况及营养状况。结果:观察组护理后转铁蛋白(TRF)、血清蛋白(AIB)及前白蛋白(PAB)指标水平均明显高于对照组,差异有统计学意义(P<0.05);观察组护理后疼痛评分明显低于对照组,差异有统计学意义(P<0.05)。结论:对于老年胃癌患者实施优质护理联合饮食改善,有助于减轻患者疼痛,并改善患者营养状况,具有较高的临床护理价值。

上海市9所医院前瞻性胃癌前病变5年随访研究

对上海市９所医院的２０００例胃癌前变化进行胃镜随访研究。随访时间：第一部分从１９８６年１月～１９９０年３月；第二部分从１９８６年１月～１９９３年６月。随访组每６～１２个月定期复查胃镜，对照组不进行主动胃镜检查，以积分法观察癌前变化。结果：第一部分随访组胃癌发生率为１．８７％（１７／９０９），其中早期胃癌占７０．６％（１２／１７）；对照组胃癌发生率为１．２５％（９／７２１），其中早期胃癌占１１．１％（１／９）。随访组病理积分从４．２５降至２．９５。第二部分仅发现１例早期胃癌（１／２６１）。本研究提示，加强对胃癌高危人群的胃镜随访是早期发现胃癌的有效方法。