The Relation Of Metabolic Syndrome With Short-Term Surgical Outcomes In Patients With Gastric Cancer

Part 1 The Relation of Metabolic Syndrome with Short-Term Surgical Outcomes in Patients with Gastric CancerBackground:As the modernization of our life style,metabolic syndrome has reached to be an epidemic level,and it is threatening people's health seriously.Studies indicated that it is not only a constellation of clinical criteria that predisposes individuals to a significant cardiovascular risk,but also associated with some chronic and acute diseases including some carcinomas,eg:breast cancer,colon-rectal cancer,prostatic cancer et al.MS has been linked to upper gastric cancer in Western populations,recently. Moreover,obesity,hypertension and diabetes are all adverse conditions for patients receiving abdominal operation.Furthermore,obesity and abdominal shape of gastric cancer patients both influence the short-term surgical outcomes of subtotal gastrectomy because of the accelerated difficulties of abdominal accessibility.Objective:To study the relation of metabolic syndrome with gastric cancer,and to evaluate the effects of metabolic syndrome on patients' surgical procedure and short-term surgical outcomes.Methods:A total of 451 male and 188 female patients underwent gastrectomy because of gastric cancer at the Affiliated Hospital of Qingdao University Medical College during January 2006 and June 2008.The mean age of the patients was 60.3±12.1 years old.Patients' medical history of hypertension and diabetes mellitus(DM) were recorded,and the parameters of MS,such as blood pressure(BP),fasting blood glucose(FBG),blood triglycerides(BTG) and blood high-density lipoprotein -cholesterol(HDL-c) were reviewed,and accordingly the patients were seperated into two groups.Then the clinical factors including the types of the operations,the duration of the operations,the amount of dissected lymph nodes,the postoperative fever,the farting time and morbidity and mortality were analyzed statistically..Results:Of 706 gastric cancer patients,69 cases(9.8%) were diagnosed with MS, and it was more common in female than in male patients(14.4%vs8.2%,P=0.034),no significant difference was found in tumor location and radical operability between the two groups(P=0.966,0.989).MS was found to correlate with the number of retrieved lymph nodes(P=0.034)and operating duration(P=0.034).The volumes of blood loss during the operating time were similar(P=0.150) between the two groups,but the MS group had more postoperative fever(P=0.015).Patients with MS experienced more postoperative complications than the non-MS group did(P=0.001),espacially the incision infection,lung infection,and delayed gastric empting(P=0.001,0.001,0.036), however,some severe complications eg:anastigmatic leakage and pulmonary embolism were not significant(P=1.000,0.345).The MS group had a longer preparation stay and total hospital stay and more hospital cost(P=0.019,0.033,0.010),their mortalities were the same(P=1.000).Conclusions:A low incidence of MS was found in Chinese patients with gastric cancer.Also upper gastric cancer does not occur more frequently in MS group than in non-MS group in our patients.But MS makes the procedure more difficult because of obesity.Longer hospital stay and more cost are essential because of more postoperative complications. Part 2 Multivariate Analysis of Relation of Metabolic Syndrome with Short-Term Surgical Outcomes in Patients with Gastric CancerObjective:To investigate the main risk factors of postoperative complications in patients with gastric cancer,and to evaluate the roles of metabolic syndrome(MS) and it's related factors.Methods:Clinical data was collected from 639 gastric cancer patients who have underwent gastrectomy during January 2006 and May 2008 at the Affiliated Hospital of Qingdao University Medical College.Single factor analysis and multivariate logistic regression analysis were used to analyse the risk factors of complication.Results:102 patients experienced different post-operative complications(15.9%). And the first three complications were lung infection(6.9%),abdominal infection(5.6%) and incision infection(2.8%).Eight factors including combined organ resection,MS, diabetes mellitus(DM),hypertension,overweight/obesity,age,duration of the operation and blood lose during the operation were related with post-operative complications.By multivariate Logistic regression analysis,five factors including combined organ resection, MS,overweight/obesity,age and duration of the operation were the main factors.Conclusions:Combined organ resection,MS,overweight/obesity,age,and duration of the operation were the main risk factors of post-operative complications in these patients with gastric cancer.MS assumes a great impact on the postoperative complications,and should be payed on more attention.