Objective To systematically evaluate the risk factors of pulmonary infection after radical gastrectomy for gastric cancer.

Method  PubMed, Web of Science, Embase, CNKI, Wanfang Database, VIP database and China Biomedical Literature Database were searched from the establishment of each database to December 17, 2021. Two researchers independently screened literatures and extracted data. NOS scale was used for quality evaluation, and RevMan 5.4, Stata 15.1 softwares were used for Meta-analysis.

Result  A total of 23 studies with a total sample size of 10,696 were included. Meta-analysis results showed that risk factors for pulmonary infection after radical gastrectomy for gastric cancer included  advanced age (OR=2.67, 95%CI: 1.90-3.74, P<0.001), smoking history (OR=3.09, 95%CI: 2.44-3.92, P<0.001), diabetes mellitus (OR=4.48, 95%CI: 1.91-10.53, P<0.001), perioperative blood transfusion (OR=4.49, 95%CI: 2.65-7.61, P<0.001), long operative time (OR=2.19, 95%CI: 1.19-4.03, P<0.001), intraoperative bleeding (OR=2.46, 95%CI: 1.62-3.74, P<0.001), long indwelling gastric tube time (OR=4.03, 95%CI: 3.74-4.33, P<0.001), nutritional risk (OR=1.82, 95%CI: 1.43-2.33, P<0.001), history of lung disease (OR=3.09, 95%CI: 1.89-5.05, P<0.001), surgical method (OR=3.33, 95%CI: 2.93-3.79, P<0.001), albumin≤30g/L (OR=1.82, 95%CI: 1.39-2.37, P<0.001), TNM staging (OR=2.18, 95%CI: 1.75-2.72, P<0.001), long drainage tube placement time (OR=1.48, 95%CI: 1.22-1.79, P<0.001), combined with underlying diseases (OR=2.48, 95%CI: 1.83-3.35, P<0.001), hypertension (OR=2.59, 95%CI: 1.48-4.52, P<0.001), hypoproteinemia (OR=3.02, 95%CI: 2.87-3.18, P<0.001), wound pain (OR=3.42, 95%CI: 1.96-5.99, P<0.001) and pulmonary insufficiency (OR=2.74, 95%CI: 1.84-4.09, P<0.001). Hemoglobin ≥110 mg/L (OR=0.67, 95%CI: 0.56-0.79, P<0.001) and forced expiratory volume in the first second (FEV1) >2 L (OR=0.22, 95%CI: 0.12-0.40, P<0.001) were protective factors for pulmonary infection after radical gastrectomy for gastric cancer.

Conclusion  The risk factors for pulmonary infection after radical gastrectomy for gastric cancer include advanced age, smoking history, perioperative blood transfusion, diabetes mellitus, hypertension history of lung disease, long operation time, intraoperative bleeding, long indwelling gastric tube time and nutritional risk. However, due to the limitations of the quality and quantity of included studies, more high-quality studies are needed to be carried out in the future.

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