Laparoscopic gastrectomy versus open gastrectomy for elderly patients with gastric cancer: a systematic review and meta-analysis

Abstract

BackgroundThe objective of this study was to evaluate the feasibility, safety, and potential benefits of laparoscopic gastrectomy (LG) comparing with open gastrectomy (OG) in elderly population.MethodsStudies comparing LG with OG for elderly population with gastric cancer, published between January 1994 and July 2015, were identified in the PubMed, Embase, and ISI Web of Science databases. Operative outcomes (intraoperative blood loss, operative time, and the number of lymph nodes harvested) and postoperative outcomes (time to first ambulation, time to first flatus, time to first oral intake, postoperative hospital stay, postoperative morbidity) were included and analyzed. The Newcastle-Ottawa Scale was used to assess the quality of the pooled study. A funnel plot was used to evaluate the publication bias.ResultsSeven studies totaling 845 patients were included in the meta-analysis. LG in comparison to OG showed less intraoperative blood loss (weighted mean difference (WMD) −127.47; 95 % confidence interval (CI) −202.79 to −52.16; P < 0.01), earlier time to first ambulation (WMD −2.07; 95 % CI −2.84 to −1.30; P < 0.01), first flatus (WMD −1.04; 95 % CI −1.45 to −0.63; P < 0.01), and oral intake (WMD −0.94; 95 % CI −1.11 to −0.77; P < 0.01), postoperative hospital stay (WMD −5.26; 95 % CI −7.58 to −2.93; P < 0.01), lower overall postoperative complication rate (odd ratio (OR) 0.39; 95 % CI 0.28 to 0.55; P < 0.01), less surgical complications (OR 0.47; 95 % CI 0.32 to 0.69; P < 0.01), medical complication (OR 0.35; 95 % CI 0.22 to 0.56; P < 0.01), incisional complication (OR 0.40; 95 % CI 0.19 to 0.85; P = 0.02), and pulmonary infection (OR 0.49; 95 % CI 0.26 to 0.93; P = 0.03). No significant differences were observed between LG and OG for the number of harvested lymph nodes. However, LG had longer operative times (WMD 15.73; 95 % CI 6.23 to 25.23; P < 0.01).ConclusionsLG is a feasible and safe approach for elderly patients with gastric cancer. Compared with OG, LG has less blood loss, faster postoperative recovery, and reduced postoperative morbidity.

Oncological Outcomes of Laparoscopic Versus Open Gastrectomy After Neoadjuvant Chemotherapy for Locally Advanced Gastric Cancer: A Retrospective Multicenter Study

“…Regarding overall postoperative complications, surgical complications, medical complications, and pulmonary infections, LG showed favorable results compared with OG. However, in terms of the number of harvested lymph nodes, both groups were comparable (P = 0.11) 17 .…”

“…Owing to its low invasiveness, shorter length of hospitalization, faster bowel movement recovery, and good cosmetic outcomes, LG has recently gained great popularity for the management of early GC [13][14][15] . Many systematic reviews proved the feasibility of LG compared with open gastrectomy (OG) in GC patients [16][17][18] . Disturbance of intraoperative circulatory and respiratory dynamics, in addition to prolonged-time of operation, are the main issues regarding LG 19 .…”

Feasibility and Effectiveness of Gastrectomy for Elderly Gastric Cancer Patients

“…Also, the survival rate in pathological I and III was similar between Elderly and non-Elderly groups. There are previous studies that have compared elderly and non-elderly; however, these studies classified the patients in vivo 33: 1307-1311 (2019) 1308 only into two groups (10,11,16). Since, younger patients have less comorbidities and longer expectancy than elderly, fine classification of patients is needed to compare the surgical short-and long-term outcomes, as in our study.…”

Surgical risk and benefits of laparoscopic surgery for elderly patients with gastric cancer: a multicenter prospective cohort study

“…Although some surgeons suggest that less invasive surgery, such as laparoscopic surgery, is of greater benefit in elderly patients [10][11][12], our previous survey on gastric cancer surgery using a national clinical database (NCD) have shown that surgeons tend to select open surgery for elderly patients [13][14][15][16]. Several clinical trials have demonstrated that the surgical outcomes of laparoscopic gastrectomy (LG) are similar or superior to those of open gastrectomy (OG) for patients with gastric cancer [17][18][19][20][21]; however, there is still little evidence of the efficacy and safety in elderly patients in routine clinical practice [22][23][24].…”