Laparoscopic versus open gastrectomy for gastric cancer patients with COPD.
BACKGROUND
Patients with chronic obstructive pulmonary disease (COPD) have a higher risk of developing postoperative pulmonary complications. Laparoscopic gastrectomy (LG) is accepted as a standard treatment for early gastric cancer. We sought to compare the clinical presentation and complications associated with LG and open gastrectomy (OG) to define the role of LG in the treatment of patients with gastric cancer and COPD.


METHODS
This was a retrospective cohort study of patients with gastric cancer and COPD who underwent gastrectomy from January 2005 to December 2007. Patients were divided into LG group and OG group according to the treatment guidelines. The stage of COPD was determined by the FEV1 ratio.


RESULTS
There were 104 patients enrolled in this study. No significant differences were observed in preoperative pulmonary function between the two groups, and most patients (99/104, 95%) were in COPD stages I and II. The changes in end-tidal CO(2) (P = 0.012) and PaCO(2) (P < 0.001) during surgery were statistically significant in the LG group. There were no significant differences in incidence of postoperative pulmonary complications between the LG (5/61, 8%) and OG (4/43, 9%) groups.


CONCLUSIONS
LG can be performed safely for patients with gastric cancer and COPD in stage I and II.
Chang
Hao-Ming
HM
Division of General Surgery, Department of Surgery, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan.
Lee
Sang-Woong
SW
Nomura
Eiji
E
Tanigawa
Nobuhiko
N
D000368:Aged; D016063:Blood Loss, Surgical; D002245:Carbon Dioxide / Q000097:blood; D015331:Cohort Studies; D005260:Female; D005743:Gastrectomy / Q000379:methods*; D006801:Humans; D010535:Laparoscopy; D007902:Length of Stay; D008297:Male; D011183:Postoperative Complications; D029424:Pulmonary Disease, Chronic Obstructive / Q000145:classification / Q000150:complications*; D012189:Retrospective Studies; D013274:Stomach Neoplasms / Q000150:complications / Q000601:surgery*; D013990:Tidal Volume
D002245:Carbon Dioxide