Optimizing postsurgical recovery for elderly patients with gastric cancer

Based on a recent study by Li et al,this editorial examines the significance of enhanced recovery after surgery(ERAS)protocols for elderly patients with gastric cancer.Cancer-related mortality,which is overwhelmingly caused by gastric cancer,calls for effective treatment strategies.Despite advances in the field of oncology,conventional postoperative care often results in prolonged hospital stays and increased complications.The aim of ERAS is to expedite recovery,reduce surgical stress,and improve patient satisfaction.The study of Li et al showed that,compared to traditional care,ERAS significantly reduces mortality risk,shortens hospital stays,and decreases postoperative complications.These findings support the widespread implementation of ERAS protocols in surgical practice to enhance patient outcomes and healthcare value.

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.

Predictive modeling for postoperative delirium in elderly patients with abdominal malignancies using synthetic minority oversampling technique

BACKGROUND Postoperative delirium,particularly prevalent in elderly patients after abdominal cancer surgery,presents significant challenges in clinical management.AIM To develop a synthetic minority oversampling technique(SMOTE)-based model for predicting postoperative delirium in elderly abdominal cancer patients.METHODS In this retrospective cohort study,we analyzed data from 611 elderly patients who underwent abdominal malignant tumor surgery at our hospital between September 2020 and October 2022.The incidence of postoperative delirium was recorded for 7 d post-surgery.Patients were divided into delirium and non-delirium groups based on the occurrence of postoperative delirium or not.A multivariate logistic regression model was used to identify risk factors and develop a predictive model for postoperative delirium.The SMOTE technique was applied to enhance the model by oversampling the delirium cases.The model’s predictive accuracy was then validated.RESULTS In our study involving 611 elderly patients with abdominal malignant tumors,multivariate logistic regression analysis identified significant risk factors for postoperative delirium.These included the Charlson comorbidity index,American Society of Anesthesiologists classification,history of cerebrovascular disease,surgical duration,perioperative blood transfusion,and postoperative pain score.The incidence rate of postoperative delirium in our study was 22.91%.The original predictive model(P1)exhibited an area under the receiver operating characteristic curve of 0.862.In comparison,the SMOTE-based logistic early warning model(P2),which utilized the SMOTE oversampling algorithm,showed a slightly lower but comparable area under the curve of 0.856,suggesting no significant difference in performance between the two predictive approaches.CONCLUSION This study confirms that the SMOTE-enhanced predictive model for postoperative delirium in elderly abdominal tumor patients shows performance equivalent to that of traditional methods,effectively addressing data imbalance.

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.

高龄胃癌患者的外科治疗及围手术期处理

背景与目的:高龄胃癌患者在提高诊治水平、制定手术方式及围手术期的处理方面仍是目前探讨的难题。本研究探讨高龄胃癌患者外科治疗和围手术期处理的有关问题。方法:回顾性分析了手术治疗的82例70岁以上胃癌病例,其中64例合并有1种或1种以上其他器官组织的疾病。结果:82例均经手术探查,其中根治性胃大部切除术56例,根治性全胃切除术9例(其中联合脏器切除3例,胰体尾及脾切除2例,合并脾脏切除1例);胃大部切除加大网膜切除术1例;姑息性切除8例;胃空肠吻合术5例;探查术3例。术后有并发症67例,围手术期死亡4例,病死率4.8%。结论:高龄胃癌患者首选还是手术治疗,只要重视手术前合并症的诊治,做好术前准备,合理选择手术方式,加强术中及术后的监测和并发症的防治,对有效降低病死率,提高生活质量有重要的意义。

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。

改良POSSUM评分系统预测老年胃癌患者术后并发症发生率的价值

目的应用改良POSSUM评分系统对预测老年胃癌患者术后并发症发生率的作用。方法根据老年胃癌患者特点,改良POSSUM评分系统中脉率、手术种类、手术范围及恶性肿瘤等四项进行替换,预测117例老年胃癌患者术后并发症的发生率,比较并发症的实际发生率与理论预测率。结果117例患者实际并发症发生率为29.91%(35例),理论预测发生率为19.65%(23例),并发症的实际发生率和理论预测率比较差异无统计学意义(χ2=3.301,P=0.069)。实际并发症组与无并发症组的生理学评分和手术侵袭度评分比较差异有统计学意义(P<0.05)。结论改良POSSUM评分系统可较好地预测老年患者胃癌术后并发症的发生率。

全麻复合硬膜外麻醉对老年胃癌患者术后认知功能及相关蛋白表达的影响

目的观察全麻复合硬膜外麻醉对老年胃癌患者术后认知功能及相关蛋白表达的影响。方法选取70例老年胃癌手术患者为研究对象,根据麻醉方式的不同分为对照组(全麻组)35例和观察组(全麻复合硬膜外麻醉组)35例。比较2组术后不同时间的认知障碍发生率、手术前后的相关蛋白(Tau蛋白、磷酸化Tau蛋白、Aβ1-40蛋白、Aβ1-42蛋白及S100B蛋白)表达情况。结果观察组术后不同时间的认知障碍发生率均低于对照组,差异有统计学意义(P<0.05)。术前2组的血清Tau蛋白、磷酸化Tau蛋白、Aβ1-40蛋白、Aβ1-42蛋白及S100B蛋白水平比较,差异均无统计学意义(P>0.05);术后观察组的血清Tau蛋白、磷酸化Tau蛋白、Aβ1-40蛋白、Aβ1-42蛋白及S100B蛋白水平均低于对照组,差异有统计学意义(P<0.05)。结论全麻复合硬膜外麻醉对老年胃癌患者术后认知功能及相关蛋白表达的影响均相对更小,在老年胃癌手术患者中的应用价值更高。

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。

老年胃癌患者手术治疗风险与肿瘤分期、术前合并症数、手术根治性及术后并发症数等疗效评价研究

目的探究老年胃癌患者进行手术治疗的相关危险因素,进一步合理指导临床手术治疗,改善患者预后生活质量。方法选取2014年1月—2016年12月在该院接受手术治疗的老年胃癌患者82例,采用随机数字分配法将胃癌患者40例作为对照组,胃癌患者42例,作为观察组,对比影响两组胃癌患者手术风险的相关因素。结果在两组术前合并症的比较中发现,观察组存在较为复杂的术前合并症,术前合并症以内科疾病为主,主要包括了高血压(42.90%)、糖尿病(17.00%)、冠心病(24.00%)、肺部疾病(31.00%)等,与对照组相比差异有统计学意义(P<0.05);脑部疾病(4.80%)、肝功能异常(9.50%)、电解质紊乱(11.90%)等合并症与对照组相比差异无统计学意义(P>0.05)。在两组术后合并症的比较中发现,与对照组术后并发症相比,观察组肺部感染(24.43%)、心律失常(16.67%)明显增加,组间差异有统计学意义(P<0.05);腹腔感染、吻合口瘘差异无统计学意义(P>0.05)。结论老年胃癌患者有自身临床表现,在对老年患者进行手术治疗前后应全面考虑影响手术及预后效果的影响因素,降低风险,提高老年胃癌患者手术后的生活质量。

探讨早中期胃癌患者手术治疗后应用品管圈健康管理的临床效果和价值

目的探讨早中期胃癌患者手术治疗后应用品管圈健康管理的临床效果和价值。方法纳入研究的患者,为2018年6月至2019年7月入院收治的早中期胃癌患者,共计73例,根据盲选法将其自由划分成对照组(n=36)和研究组(n=37)。接受常规健康管理干预的作为空白对照,设为对照组,应用品管圈健康管理作为本次实验对象,设为研究组,观察对比两组患者在不同健康管理方式下的临床效果。结果护理前,两组患者的焦虑、抑郁症状较为严重,对比两组的生活质量评分,其差异不明显(P>0.05);护理后,两组的生活质量评分均有所提升,但是两组患者护理后的数据对比,研究组心理因素、生理因素、环境因素以及社会关系评分高于对照组,但是研究组患者的SAS、SDS评分均低于对照组,研究组患者的护理满意度评分高于对照组,将两组的相关指标进行对比与统计,组间差异显著(P<0.05),存在统计学意义。结论早中期胃癌患者在接受手术治疗后,护理人员采用品管圈护理,能够改善患者的心理健康程度,积极发挥患者主观能动性,进而提升患者的治疗效果,提升患者的生活质量,最终构建和谐护患关系。该研究结果证实了品管圈护理值得在临床上进行推广。

高脂血症对胃癌患者开腹手术后合并症的影响

目的研究高脂血症对胃癌患者开腹手术后合并症的影响。方法在2007年5月—2011年6月间的本院胃肠外科肿瘤患者开腹手术者中,随机选取61病例合并高脂血症患者和61例血脂正常的胃癌开腹手术者作为对照组进行研究,了解高脂血症对胃癌手术后合并症的影响。结果手术时间、术中出血量和病人总住院时间在两组间比较,差异具有统计学意义,但术后并发症,主要是切口感染情况、吻合口瘘和肠梗阻的发生在两组间的差异并无统计学意义。结论高脂血症合并者的手术前需注重血脂的控制。