title: Potentially fatal complications for elderly patients after laparoscopy-assisted distal gastrectomy.
abstract: BACKGROUND
  The safety of surgery for gastric cancer in the elderly has been shown previously. However, potentially fatal complications based on an established severity grading system were not well described, and associated risk factors have not been assessed. The present study sought to examine severity-dependent postoperative complications after laparoscopy-assisted distal gastrectomy (LADG) in elderly patients and risk factors of potentially fatal postoperative complications.
  
  
  METHODS
  The study included 189 patients aged 70 years or older and who underwent LADG for early gastric cancer. Patient characteristics, perioperative outcomes, postoperative complications including severity assessment using the Clavien-Dindo classification, and risk factors related to postoperative complications were analyzed.
  
  
  RESULTS
  The overall complication rate was 24.9 % (47/189). The most frequent complication was abdominal fluid collection (9 cases, 4.8 %). Severe complications classified as grade III or above in the Clavien-Dindo grading system were found in 20 (10.6 %) patients. Multivariate analysis identified preoperative serum albumin concentration (odds ratio, 5.200; 95 % CI, 1.706-15.850), Roux-en-Y reconstruction (odds ratio, 3.611; 95 % CI, 1.103-11.817), and simultaneous cholecystectomy (odds ratio, 5.008; 95 % CI, 1.378-18.201) as independent predictors of a higher rate of severe postoperative complications after LADG in elderly patients.
  
  
  CONCLUSIONS
  The incidence of severe complications after LADG in the elderly was quite acceptable considering the risks associated with radical surgery with extensive lymphadenectomy. Preoperative serum concentrations of albumin (<4.0 g/dl), Roux-en-Y reconstruction, and simultaneous cholecystectomy are independent risk factors for severe postoperative complications in these patients.
authors.affiliation: Department of Gastroenterological Surgery, Cancer Institute Hospital, Japanese Foundation for Cancer Research, 3-8-31 Ariake, Koto-ku, Tokyo, 135-8550, Japan.
authors.forename: Koshi
authors.initials: K
authors.lastname: Kumagai
authors.forename: Naoki
authors.initials: N
authors.lastname: Hiki
authors.forename: Souya
authors.initials: S
authors.lastname: Nunobe
authors.forename: Xiaohua
authors.initials: X
authors.lastname: Jiang
authors.forename: Takeshi
authors.initials: T
authors.lastname: Kubota
authors.forename: Susumu
authors.initials: S
authors.lastname: Aikou
authors.forename: Shinya
authors.initials: S
authors.lastname: Tanimura
authors.forename: Takeshi
authors.initials: T
authors.lastname: Sano
authors.forename: Toshiharu
authors.initials: T
authors.lastname: Yamaguchi
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000713:Anastomosis, Roux-en-Y / Q000009:adverse effects / Q000379:methods; D002763:Cholecystectomy / Q000009:adverse effects / Q000379:methods; D005260:Female; D005743:Gastrectomy / Q000009:adverse effects / Q000379:methods*; D006801:Humans; D015994:Incidence; D010535:Laparoscopy / Q000009:adverse effects / Q000379:methods*; D008297:Male; D015999:Multivariate Analysis; D011183:Postoperative Complications / Q000453:epidemiology*; D012307:Risk Factors; D012709:Serum Albumin / Q000378:metabolism; D012720:Severity of Illness Index; D013274:Stomach Neoplasms / Q000473:pathology / Q000601:surgery*
chemical_list: D012709:Serum Albumin