In a groundbreaking meta-analysis published in BMC Cancer, researchers have illuminated the complex landscape of risk factors contributing to pneumonia in patients undergoing radical gastrectomy for gastric cancer. This extensive study systematically pooled evidence from over 20,000 patients, providing the most comprehensive insight to date on postoperative pneumonia—a serious complication that significantly impacts patient recovery and survival.
Radical gastrectomy, a mainstay surgical intervention for managing gastric cancer, involves extensive removal of stomach tissue and regional lymph nodes. While this procedure is often lifesaving, it carries a risk of postoperative complications, with pneumonia presenting a major cause of morbidity and prolonged hospitalization. Understanding which patients are at highest risk is critical for clinicians aiming to tailor perioperative care and mitigate adverse outcomes.
The study employed rigorous standards aligned with the PRISMA 2020 guidelines, ensuring a meticulous synthesis of available data. Researchers scoured numerous medical databases—including Chinese Wan Fang, CNKI, VIP, Embase, MEDLINE, PubMed, and Cochrane Library—gathering cohort and case–control studies published up to January 20, 2024. The meta-analysis not only quantified the pooled prevalence of pneumonia but also identified fifteen distinct risk factors with statistical significance.
Their findings revealed that approximately 11% of patients developed pneumonia following radical gastrectomy. This relatively high prevalence underscores the necessity for improved strategies focused on respiratory complication prevention. Among the fifteen identified risk factors, several emerged as particularly potent contributors, magnifying the risk by more than twofold. These included smoking history, prolonged retention of nasogastric tubes post-surgery, intraoperative bleeding exceeding 200 milliliters, and comorbidities such as diabetes mellitus and chronic obstructive pulmonary disease (COPD).
Notably, male gender and total gastrectomy—an extensive surgical variant involving the complete removal of the stomach—were linked with drastically increased susceptibility. Male patients appeared over three times more likely to develop postoperative pneumonia, a finding that invites further exploration into gender-related immunological or physiological differences affecting pulmonary vulnerability.
Intraoperative factors also carried substantial weight. Excessive bleeding during surgery possibly alters systemic inflammatory responses, impairing pulmonary defenses and contributing to infection risk. Similarly, prolonged nasogastric tube use—often necessary for gastric decompression and nutritional management—was implicated in nearly doubling pneumonia risk, likely due to mechanical irritation and increased aspiration potential.
Comorbid conditions emerged as critical determinants. Patients with pre-existing COPD faced nearly a fivefold increase in pneumonia risk, highlighting the compounded threat when chronic respiratory insufficiency intersects with major abdominal surgery. Diabetes mellitus, another formidable risk factor, was associated with more than four times greater odds of pneumonia, reflecting impaired immune responses and delayed wound healing characteristic of hyperglycemic states.
The extent of surgical intervention, such as D2 lymphadenectomy, involving the removal of additional lymph nodes, also correlated strongly with pneumonia prevalence. This association may relate to prolonged operative time and greater physiological stress, factors known to compromise pulmonary function postoperatively. Similarly, perioperative blood transfusions carried significant risk, potentially due to immunomodulatory effects and inflammation induced by transfused blood products.
Moderate yet clinically important risk factors were also delineated, including advanced age, poor nutritional status, longer surgery duration, and prior pulmonary disease history. These elements collectively illustrate the multifaceted nature of pneumonia risk, integrating patient intrinsic factors, surgical complexity, and perioperative management practices.
The study’s conclusions emphasize a multi-pronged approach to reducing pneumonia incidence, advocating for targeted preventive measures. Smoking cessation before surgery stands out as a paramount intervention, given the robust association of smoking history with pneumonia. Optimizing nutritional status prior to and following surgery can bolster immune defenses, while stringent blood glucose and blood pressure control limits systemic vulnerabilities.
Perioperative respiratory training, aimed at enhancing lung expansion and mucociliary clearance, represents another vital strategy. Minimizing the duration of nasogastric tube placement reduces mechanical injury and aspiration risk, whereas judicious use of blood transfusions, avoiding unnecessary administration, might mitigate immunosuppression and inflammatory exacerbation.
For patients identified as high-risk—particularly older individuals, those undergoing total gastrectomy or prolonged operations, and those with significant intraoperative bleeding—heightened postoperative surveillance is essential. Early detection and rapid intervention in suspected pneumonia cases can significantly improve clinical trajectories, reducing the likelihood of serious complications such as sepsis and respiratory failure.
This meta-analysis not only advances clinical understanding but also serves as a call to action for perioperative teams to integrate comprehensive risk assessments into surgical planning and patient education. The interplay of modifiable factors highlights opportunities to refine standardized protocols and personalize care pathways, ultimately improving survival and quality of life after radical gastrectomy.
With gastric cancer remaining a global health challenge, especially in regions with high incidence rates, the implications of this study resonate widely. Surgeons, anesthesiologists, and specialized nursing staff are urged to collaborate closely, balancing oncological imperatives with optimal supportive care frameworks that address respiratory risk.
Equipped with clearer evidence on risk stratification, future clinical trials may explore novel interventions, such as enhanced respiratory physiotherapy, advanced glycemic monitoring, and innovative surgical techniques aimed at reducing operative stress. Additionally, research into gender-specific immune responses to infection could unlock further insights into tailored measures for male patients most vulnerable to postoperative pneumonia.
Overall, this comprehensive evaluation represents a significant leap forward. By synthesizing data across diverse populations and healthcare settings, the study embodies the power of meta-analytic approaches to distill actionable knowledge from expansive datasets. It reaffirms the centrality of multidisciplinary care models to mitigate complex surgical complications and to promote recovery excellence for patients battling gastric cancer.
As the oncology community strives for better outcomes and fewer setbacks, integrating these findings into clinical guidelines will be a vital step. Enhanced preoperative optimization, vigilant intraoperative management, and robust postoperative protocols aligned with identified risk factors herald a new era in mitigating pneumonia risk—a development that promises to improve prognosis and alleviate healthcare burdens worldwide.
Subject of Research: Risk factors contributing to pneumonia following radical gastrectomy for gastric cancer
Article Title: Risk factors for pneumonia after radical gastrectomy for gastric cancer: a systematic review and meta-analysis
Article References:
Fan, S., Jiang, H., Xu, Q. et al. Risk factors for pneumonia after radical gastrectomy for gastric cancer: a systematic review and meta-analysis. BMC Cancer 25, 840 (2025). https://doi.org/10.1186/s12885-025-14149-1
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