| [Aim] To analyse the risky factors of surgical treatment of elderly patients with gastric cancer, to evaluate the perioperative risks and short/long term outcomes, in order to find out the factors associated with the surgical curative effect.[Methods] To collect the clinical, pathological and follow-up materials of elderly patients (65years old and above) with gastric cancer, whose surgical treatments had been accomplished in general surgery department of Huashan Hospital during March2008to November2011. A retrospective analysis was made in order to investigate the relations between the age, the preoperative comorbidities, the conditions of surgeries, the pathological findings and the incidence rate of postoperative complications, short-term efficacy,overall prognosis.[Result] Totally142patients were collected in this study, including61patients in aged group(75years old and above), others in elderly group. There was no statistical difference in the distributions of the locations of tumors, surgical approachs, radical surgeries,the amount of blood loss, operative time and pathological results. Aged group had a higher incidence rate of preoperative comorbidities (88.5%) than elderly group(56.8%)(P<0.05). Among the comorbidities, hypertension, diabetes, coronary heart disease and malnutrition were main influencing factors. There was no significant difference of the incidence of postoperative complications, the postoperative time when oral intake of liquid diet and the over-all prognosis between two groups(P>0.05). The aged group had a little more postoperative days of hospitalization than the other group (P=0.006). According to Kaplan-Meier survival analysis and Log Rank test, over-all prognosis was affected by tumor stage, the number of preoperative comorbidities, radical surgeries and the number of postoperative complications (P<0.05). COX multivariate logistic regression analysis displayed the number of postoperative complications was the most important factor for postoperative complications(P=0.026). Further more, logistic regression analysis obtained the operative time was the main factor affecting the incidence of postoperative complications (P=0.005)。[Conclusion] Tumor stage, radical surgery, the number of preoperative comorbidities and postoperative complications are the main factor to affect the overall prognosis of elderly patients with gastric cancer after surgical treatment. The length of time during surgery is an important factor causing the postoperative complications for elderly patients with gastric cancer. Although elderly patients often suffer many kinds of diseases, age is still not a restricted factor of surgery for the elderly even more advanced aged patients, so long as enough attention ts are paid to the perioperative treatments, and reasonable surgical schemes are chosen.The effect and safety of surgical treatments will not be affected by age. [Aim] Taking patients with gastric cancer as objects, to study the possibility of serum macrophage associated colony stimulating factors as new types of tumor markers.[Methods] To collect the serum of patients, who came to the department of general surgery of Huashan Hospital during July2010to December2011, because of stomach diseases initial diagnosed by gastroscopy. Serum levels of M-CSF and GM-CSF were measured by ELISA. To analysis the variation of the serum level of two colony stimulating factors, comparing with the traditional tumor markers, combined of clinical and pathological materials.[Result] Totally40patients were collected, including32patients in gastric cancer group and8patients in non-gastric cancer group. The follow-up study did not undergo, because the sample size of the end of event was too small. The levels of CEA, M-CSF and GM-CSF were significant higher in gastric cancer group than non-gastric cancer group(P<0.05). CEA levels were significantly elevated, when the gastric cancer lesions infiltrated the serosa(P=0.046). The increased levels of M-CSF were statistical significance, when the lymph nodes were involved by gastric cancer. When distant metastasis had happened in patients with gastric cancer, the levels of M-CSF and GM-CSF reduced obviously(P value0.026and0.043), however the ratio of CEA value and M-CSF value was significantly increased(P=0.048).[Conclusion] M-CSF and GM-CSF could be considered as new types of tumor markers. The level of M-CSF elevated in patients with gastric cancer, whose lymph nodes had already been involvement. Colony stimulating factor levels was positively correlated with TNM stage in gastric cancer patients without distant organ metastasis. The level of macrophage associated colony stimulating factors often declined abnormally in patients with gastric cancer who had occurred distant organ metastasis. It could be used to estimate whether the cancer had migrated to distant organs, combined with traditional tumor markers. |
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