Long-term impact of postoperative pneumonia after curative gastrectomy for elderly gastric cancer patients

With the extension of life expectancy, cancer has been increasing in elderly populations. Postoperative pneumonia can negatively influence immediate mortality following gastrectomy for elderly patients, but its impact on long-term survival remains unclear. We retrospectively reviewed the cases of patients aged ≥75 years who underwent curative gastrectomy for gastric cancer from 2000 to 2014 to determine the long-term effects of postoperative pneumonia and to identify independent risk factors along with physical status and surgical procedure. Of 250 patients, 32 (12.8%) developed postoperative pneumonia. Patients with postoperative pneumonia had significantly worse overall survival (OS) than those without postoperative pneumonia (P<.001). A multivariate analysis identified postoperative pneumonia as a prognostic factor for OS (hazard ratio, 2.06; 95% CI, 1.05-3.75; P=.036). Significant risk factors for the development of postoperative pneumonia were male gender (P=.026) and D2 lymphadenectomy (P<.001). D2 lymphadenectomy was associated with poorer OS than D1 or D1+lymphadenectomy in patients with an American Society of Anesthesiologists (ASA) score 3 (P=.026), but did not influence OS negatively in patients with an ASA score ≤2. Limited lymphadenectomy did not affect the cancer-specific survival of elderly patients with ASA score 3. Postoperative pneumonia following gastrectomy has an adverse impact on the long-term survival of elderly gastric cancer patients. A limited lymphadenectomy during curative resection should be considered to prevent postoperative pneumonia in frail elderly patients with ASA score 3. Postoperative pneumonia following gastrectomy has an adverse impact on the long-term survival of elderly gastric cancer patients. Extent of lymph node dissection during curative resection should be limited to prevent postoperative pneumonia, based on the patient's frailty.