Analysis of risk factors on pulmonary infection after D2 lymphadenectomy gastrectomy for gastric cancer / 中华胃肠外科杂志

ABSTRACT

<p><b>OBJECTIVE</b>To explore the risk factors of pulmonary infection after D2 radical gastrectomy of gastric cancer in order to guide clinical measures to reduce the incidence of pulmonary infection.</p><p><b>METHODS</b>Clinical data of 371 patients undergoing D2 radical gastrectomy at Division 2 of Gastrointestinal Cancer Center from October 2014 to October 2016 were collected for retrospective cohort study. Associated risk factors of pulmonary infection after D2 radical gastrectomy of gastric cancer were analyzed. Diagnosis criteria of pulmonary infection occurrence of new pulmonary rales; new infiltrative change or consolidation in chest by imaging examination; with at least one of the following temperature ≥38.5centi-degree, emergence of new purulent sputum or sputum character change, isolated pathogens from bronchial brush biopsy or tracheal secretion culture.</p><p><b>RESULTS</b>Of 371 patients, 265 were males and 106 were females. The average age was 59.1(22-80) years old. There were 38(10.2%) cases of pulmonary infection after radical resection of gastric cancer. Univariate analysis showed that smoking history, intra-operative blood loss ≥200 ml, total gastrectomy, and gastric intubation ≥6 d were associated with pulmonary infection after D2 radical gastrectomy (all P<0.05). Six cases quitted smoking 2 weeks before operation with pulmonary infection incidence of 8.1%(6/74), and 16 patients did not quit smoking 2 weeks before operation with pulmonary infection incidence of 21.1%(16/76), and the difference was statistically significant (χ=4.0387, P=0.0445). Multivariate Logistic regression analysis showed that postoperative gastric intubation ≥6 d (OR=4.335, 95%CI 1.088 to 4.586, P=0.05), smoking history (OR=3.469, 95%CI 1.056 to 5.252, P=0.043) and intra-operative blood loss ≥200 ml (OR=3.931, 95%CI 1.350 to 10.574, P=0.013) were independent risk factors of pulmonary infection after D2 radical gastrectomy of gastric cancer.</p><p><b>CONCLUSION</b>For gastric cancer patients undergoing D2 radical gastrtectomy with smoking history, greater blood loss during operation and postoperative gastric intubation ≥6 d, surgeons must pay attention to the prevention of postoperative pulmonary infection.</p>