[Feasibility of radical laparoscopy-assisted gastrectomy for patients with chronic obstructive pulmonary disease].
OBJECTIVE
To assess the effect of radical laparoscopy-assisted gastrectomy(LG) for patients with chronic obstructive pulmonary disease (COPD).


METHODS
Clinical data of 340 gastric cancer patients with COPD undergoing radical gastrectomy with lymphadenectomy at Southwest Hospital, Third Military Medical University between January 2010 and October 2013 were analyzed retrospectively. The clinical outcomes for the 262 patients with COPD who underwent LG(LG group) were compared with those of 78 patients with COPD who underwent open gastrectomy(OG group). During LG, pneumoperitoneum was maintained at an insuffiation pressure of 8 mmHg to 10 mmHg. The primary endpoint was postoperative pulmonary complication(PPC). To predict factors related to PPC, univariate and multivariate logistic analyses were carried out.


RESULTS
Intraoperative blood loss was significantly less in the LG group [(131.2±14.7) ml] than in the OG group [(246.7±49.0) ml; t=-13.445, P=0.000], but operation time was significantly longer [(220.4±19.1) min vs. (194.2±31.5) min; t=6.877, P=0.000]. The findings showed PPC to be significantly less frequent in the LG group(5.3%,14/262) than in the OG group (15.4%, 12/78)(χ(2)=8.581, P=0.003). The severity of COPD was independent risk factor for PPC(P=0.031, HR=1.456, 95%CI:1.306-1.789). No independent predictor of PPCs was found in type of operative approach (open vs laparoscopic; P=0.126).


CONCLUSIONS
The LG procedure with insuffiation pressure of pneumoperitoneum is tolerated for gastric cancer patients with mild or moderate COPD.
Center of General Surgery of PLA, Southwest Hospital, Third Military Medical University, Chongqing 400038, China. yupeiwu01@vip.sina.com.
Ao
A
Xu
Yongliang
Y
Zhao
Feng
F
Qian
Yan
Y
Shi
Yingxue
Y
Hao
Bo
B
Tang
Huaxing
H
Luo
Peiwu
P
Yu
D016063:Blood Loss, Surgical; D005240:Feasibility Studies; D005743:Gastrectomy; D006801:Humans; D010535:Laparoscopy; D008197:Lymph Node Excision; D061646:Operative Time; D011183:Postoperative Complications; D029424:Pulmonary Disease, Chronic Obstructive / Q000150:complications*; D012189:Retrospective Studies; D012307:Risk Factors; D013274:Stomach Neoplasms / Q000150:complications / Q000601:surgery*