Safety and feasibility of laparoscopic gastrectomy for patients with gastric cancer in the elderly_CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Authors：

LUO Yuwen ^1,2 ,  WANG Junjiang ² , FENG Xingyu ² , YANG Zifeng ² , ZHENG Jiabin ² ,  LI Yong ^1,2

1. The Second Clinical Medical College of Southern Medical University, Guangzhou 510515, P. R. China;
2. Department of General Surgery, Guangdong Academy of Medical Sciences and Guangdong General Hospital, Guangzhou 510080, P. R. China;

Corresponding?author：

LI Yong, Email: yuan821007@126.com

Keywords：

elderly; gastric cancer; laparoscope; complication

DOI：

10.7507/1007-9424.201702038

Video：

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Objective To assess safety and feasibility of laparoscopic gastrectomy in the elderly with gastric cancer. Methods From January 2010 to September 2014, 146 elderly (age ≥65 years old) patients with gastric cancer underwent radical operations in the Department of General Surgery, Guangdong Academy of Medical Sciences and Guangdong General Hospital were collected, then were divided into a laparoscopy-assisted radical gastrectomy (LAG group, n=40) and an open radical gastrectomy (OG group, n=106) according to the operative mode. The differences of intraoperative and postoperative situation, and the postoperative complications were analyzed between the LAG group and the OG group. Results ① The age, gender, body mass index, albumin, ASA grade, tumor location, differentiation degree, TNM stage, radical gastrectomy, and digestive tract anastomosis had no significant differences between the LAG group and the OG group (P>0.05). ② None of the patients died during the operative period and there was no significant difference in the mean number of retrieved lymph nodes between these two groups (P>0.05). In the aspects of the intraoperative blood loss, the first flatus time or the first feeding time, and the postoperative hospitalization stay in the LAG group were significantly less than those in the OG group (P<0.05). For the operative time, the OG group showed a distinctive advantage with a significantdifference than the LAG group (P<0.05). ③ The rate of postoperative complication in the LAG group and OG group was 10.0% (4/40) and 15.1% (16/106) respectively, and the difference was not significant (χ²=0.64, P=0.591), the grade of the Clavien-Dindo complications had no significant difference (χ²=0.63, P=0.592). ④ None of the patients died following operation in the LAG group and one case died in the OG group because of the respiratory and circulatory failure caused by the pulmonary embolism. Conclusion Preliminary results of limited cases in this study show that LAG in the elderly patients with gastric cancer could reduce intraoperative blood loss, shorten the first flatus time or the first feeding time, and postoperative hospitalization stay, could obtain same radical effect without increasing incidence of postoperative complications as compared with OG, so it is safety and feasible.

Citation： LUO Yuwen, WANG Junjiang, FENG Xingyu, YANG Zifeng, ZHENG Jiabin, LI Yong. Safety and feasibility of laparoscopic gastrectomy for patients with gastric cancer in the elderly. CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY, 2017, 24(9): 1076-1080. doi: 10.7507/1007-9424.201702038 Copy

1.	Nashimoto A. Current status of treatment strategy for elderly patients with gastric cancer. Int J Clin Oncol, 2013, 18(6): 969-970.
2.	Cuschieri A, Fayers P, Fielding J, et al. Postoperative morbidity and mortality after D1 and D2 resections for gastric cancer: preliminary results of the MRC randomised controlled surgical trial. The Surgical Cooperative Group. Lancet, 1996, 347(9007): 995-999.
3.	Bonenkamp JJ, Hermans J, Sasako M, et al. Extended lymph-node dissection for gastric cancer. N Engl J Med, 1999, 340(12): 908-914.
4.	Schwarz RE, Smith DD. Extended lymph node dissection for gastric cancer: who may benefit? Final results of the randomized Dutch gastric cancer group trial. J Clin Oncol, 2005, 23(23): 5404-5405.
5.	Tsujinaka T, Sasako M, Yamamoto S, et al. Influence of overweight on surgical complications for gastric cancer: results from a randomized control trial comparing D2 and extended para-aortic D3 lymphadenectomy (JCOG9501). Ann Surg Oncol, 2007, 14(2): 355-361.
6.	Tanimura S, Higashino M, Fukunaga Y, et al. Laparoscopic gastrectomy for gastric cancer: experience with more than 600 cases. Surg Endosc, 2008, 22(5): 1161-1164.
7.	Maeda H, Okabayashi T, Ichikawa K, et al. Colorectal cancer surgery in patients older than 80 years of age: experience at one nonteaching hospital in Japan. Am Surg, 2011, 77(11): 1454-1459.
8.	Bufalari A, Giustozzi G, Burattini MF, et al. Rectal cancer surgery in the elderly: a multivariate analysis of outcome risk factors. J Surg Oncol, 2006, 93(3): 173-180.
9.	Zucchetti F, Negro F, Matera D, et al. Gastric cancer in the elderly. Ann Ital Chir, 2001, 72(2): 181-186.
10.	Kitano S, Iso Y, Moriyama M, et al. Laparoscopy-assisted Billroth Ⅰ gastrectomy. Surg Laparosc Endosc, 1994, 4(2): 146-148.
11.	王紅巖, 趙曉丹, 李國勝, 等. 腹腔鏡輔助與開腹胃癌 D2 根治術治療局部進展期遠端胃癌的安全性及近期療效Meta分析. 中國醫科大學學報. 2015, 44(3): 252-258.
12.	黃昌明, 陸俊. 腹腔鏡胃癌手術相關并發癥防治. 中國實用外科雜志, 2013, 33(4): 298-301.
13.	李國新, 胡彥鋒, 劉浩. 中國腹腔鏡胃腸外科研究組 CLASS-01 研究進展. 中華消化外科雜志, 2017, 16(1): 38-42.
14.	孟春燕, 黃昌明. 腹腔鏡輔助胃癌根治術在老年人胃癌中的應用. 福建醫科大學, 2011.
15.	Yasuda K, Sonoda K, Shiroshita H, et al. Laparoscopically assisted distal gastrectomy for early gastric cancer in the elderly. Br J Surg, 2004, 91(8): 1061-1065.
16.	Dindo D, Demartines N, Clavien PA. Classification of surgical complications: a new proposal with evaluation in a cohort of 6 336 patients and results of a survey. Ann Surg, 2004, 240(2): 205-213.
17.	Agnelli G1, Becattini C. Acute pulmonary embolism. N Engl J Med, 2010, 363(3): 266-274.

1. Nashimoto A. Current status of treatment strategy for elderly patients with gastric cancer. Int J Clin Oncol, 2013, 18(6): 969-970.
2. Cuschieri A, Fayers P, Fielding J, et al. Postoperative morbidity and mortality after D1 and D2 resections for gastric cancer: preliminary results of the MRC randomised controlled surgical trial. The Surgical Cooperative Group. Lancet, 1996, 347(9007): 995-999.
3. Bonenkamp JJ, Hermans J, Sasako M, et al. Extended lymph-node dissection for gastric cancer. N Engl J Med, 1999, 340(12): 908-914.
4. Schwarz RE, Smith DD. Extended lymph node dissection for gastric cancer: who may benefit? Final results of the randomized Dutch gastric cancer group trial. J Clin Oncol, 2005, 23(23): 5404-5405.
5. Tsujinaka T, Sasako M, Yamamoto S, et al. Influence of overweight on surgical complications for gastric cancer: results from a randomized control trial comparing D2 and extended para-aortic D3 lymphadenectomy (JCOG9501). Ann Surg Oncol, 2007, 14(2): 355-361.
6. Tanimura S, Higashino M, Fukunaga Y, et al. Laparoscopic gastrectomy for gastric cancer: experience with more than 600 cases. Surg Endosc, 2008, 22(5): 1161-1164.
7. Maeda H, Okabayashi T, Ichikawa K, et al. Colorectal cancer surgery in patients older than 80 years of age: experience at one nonteaching hospital in Japan. Am Surg, 2011, 77(11): 1454-1459.
8. Bufalari A, Giustozzi G, Burattini MF, et al. Rectal cancer surgery in the elderly: a multivariate analysis of outcome risk factors. J Surg Oncol, 2006, 93(3): 173-180.
9. Zucchetti F, Negro F, Matera D, et al. Gastric cancer in the elderly. Ann Ital Chir, 2001, 72(2): 181-186.
10. Kitano S, Iso Y, Moriyama M, et al. Laparoscopy-assisted Billroth Ⅰ gastrectomy. Surg Laparosc Endosc, 1994, 4(2): 146-148.
11. 王紅巖, 趙曉丹, 李國勝, 等. 腹腔鏡輔助與開腹胃癌 D2 根治術治療局部進展期遠端胃癌的安全性及近期療效Meta分析. 中國醫科大學學報. 2015, 44(3): 252-258.
12. 黃昌明, 陸俊. 腹腔鏡胃癌手術相關并發癥防治. 中國實用外科雜志, 2013, 33(4): 298-301.
13. 李國新, 胡彥鋒, 劉浩. 中國腹腔鏡胃腸外科研究組 CLASS-01 研究進展. 中華消化外科雜志, 2017, 16(1): 38-42.
14. 孟春燕, 黃昌明. 腹腔鏡輔助胃癌根治術在老年人胃癌中的應用. 福建醫科大學, 2011.
15. Yasuda K, Sonoda K, Shiroshita H, et al. Laparoscopically assisted distal gastrectomy for early gastric cancer in the elderly. Br J Surg, 2004, 91(8): 1061-1065.
16. Dindo D, Demartines N, Clavien PA. Classification of surgical complications: a new proposal with evaluation in a cohort of 6 336 patients and results of a survey. Ann Surg, 2004, 240(2): 205-213.
17. Agnelli G1, Becattini C. Acute pulmonary embolism. N Engl J Med, 2010, 363(3): 266-274.

CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Safety and feasibility of laparoscopic gastrectomy for patients with gastric cancer in the elderly

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