title: Feasibility of laparoscopy-assisted gastrectomy for patients with chronic obstructive pulmonary disease.
abstract: BACKGROUND
  Laparoscopy-assisted gastrectomy (LG) is an established treatment for early gastric cancer. However, carbon dioxide pneumoperitoneum during laparoscopic surgery can adversely affect the pulmonary function of patients with chronic obstructive pulmonary disease (COPD). This retrospective cohort study was performed to assess the feasibility of LG for patients with COPD.
  
  
  METHODS
  Among 1,053 patients who underwent radical gastrectomy with lymph node dissection between 1999 and 2011 at the authors' hospital, 220 patients with COPD were studied retrospectively. The clinical outcomes for the patients with COPD who underwent LG (LG group) were compared with those of COPD patients who underwent open gastrectomy (OG group), as well as those of patients with no operative risk and normal pulmonary function who underwent LG (NOR group). Postoperative pulmonary complications (PPCs) were defined as pneumonia, atelectasis, pneumothorax, prolonged mechanical ventilation (>24 h), and adult respiratory distress syndrome within 30 days after operation.
  
  
  RESULTS
  Pulmonary function variables were similar in the LG and OG groups. The findings showed PPCs to be slightly but not significantly less frequent in the LG group (1.7 %) than in the OG group (6.3 %) (p = 0.09). No difference in PPCs was found between the LG group and the NOR group (p > 0.99). For patients with COPD, advanced stage (stage 2 or 3 vs stage 1) was significantly associated with PPCs (p = 0.03), but was not an independent risk factor for PPCs (p = 0.12).
  
  
  CONCLUSIONS
  The LG procedure is tolerated in patients with gastric cancer who have mild or moderate COPD, similar to OG.
authors.affiliation: Department of Esophagogastric Surgery, Tokyo Medical and Dental University, 1-5-45, Yushima, Bunkyo-ku, Tokyo, 113-8519, Japan. m-inokuchi.srg2@tmd.ac.jp
authors.forename: Mikito
authors.initials: M
authors.lastname: Inokuchi
authors.forename: Kazuyuki
authors.initials: K
authors.lastname: Kojima
authors.forename: Keiji
authors.initials: K
authors.lastname: Kato
authors.forename: Kazuo
authors.initials: K
authors.lastname: Motoyama
authors.forename: Hirofumi
authors.initials: H
authors.lastname: Sugita
authors.forename: Kenichi
authors.initials: K
authors.lastname: Sugihara
mesh_terms: D000368:Aged; D005240:Feasibility Studies; D005260:Female; D005541:Forced Expiratory Volume / Q000502:physiology; D005743:Gastrectomy / Q000379:methods*; D006801:Humans; D010535:Laparoscopy / Q000379:methods*; D008197:Lymph Node Excision / Q000379:methods; D008297:Male; D011183:Postoperative Complications / Q000209:etiology; D029424:Pulmonary Disease, Chronic Obstructive / Q000150:complications* / Q000503:physiopathology; D012189:Retrospective Studies; D012307:Risk Factors; D013274:Stomach Neoplasms / Q000150:complications / Q000601:surgery*; D014797:Vital Capacity / Q000502:physiology