Laparoscopically assisted distal gastrectomy for early gastric cancer in the elderly

Yasuda, Kazuhiro; Sonoda, Kazuya; Shiroshita, Hidefumi; Ito, Masafumi; Shiraishi, Norio; Kitano, Seigo

doi:10.1002/bjs.4615

Cited by 78 publications

(58 citation statements)

References 22 publications

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“…The incidence of complications classified as grade III or above in the Clavien-Dindo grading system was approximately 10 % in our cohort. This rate was relatively low and satisfactory compared with previous studies [18,19,21], especially considering that we performed radical surgery involving modified D2 lymph node dissection with curative intent. Median postoperative hospital stay (range) was 11 (7-55) days, which did not seem to be different from previously reported postoperative stay after LADG in all age groups, although statistical analysis was not performed [33].…”

Section: Discussionsupporting

confidence: 62%

“…Several previous studies indicating the feasibility of LAG in the elderly concluded that LAG produces an incidence rate of postoperative complications in the elderly similar to that in younger patients [18][19][20][21]. However, the definition of complication severities after LAG in the elderly was not strictly defined in these previous reports.…”

Section: Discussionmentioning

confidence: 97%

“…Although several studies found no significant difference in the incidence of postoperative complications between elderly and younger patients undergoing LAG [18][19][20][21], severity of complications was poorly defined in most of these studies.…”

Section: Introductionmentioning

confidence: 97%

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Potentially fatal complications for elderly patients after laparoscopy-assisted distal gastrectomy

et al. 2013

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Background The safety of surgery for gastric cancer in the elderly has been shown previously. However, potentially fatal complications based on an established severity grading system were not well described, and associated risk factors have not been assessed. The present study sought to examine severity-dependent postoperative complications after laparoscopy-assisted distal gastrectomy (LADG) in elderly patients and risk factors of potentially fatal postoperative complications. Methods The study included 189 patients aged 70 years or older and who underwent LADG for early gastric cancer. Patient characteristics, perioperative outcomes, postoperative complications including severity assessment using the Clavien-Dindo classification, and risk factors related to postoperative complications were analyzed. Results The overall complication rate was 24.9 % (47/189). The most frequent complication was abdominal fluid collection (9 cases, 4.8 %). Severe complications classified as grade III or above in the Clavien-Dindo grading system were found in 20 (10.6 %) patients. Multivariate analysis identified preoperative serum albumin concentration (odds ratio, 5.200; 95 % CI, 1.706-15.850), Roux-en-Y reconstruction (odds ratio, 3.611; 95 % CI, 1.103-11.817), and simultaneous cholecystectomy (odds ratio, 5.008; 95 % CI, 1.378-18.201) as independent predictors of a higher rate of severe postoperative complications after LADG in elderly patients. Conclusion The incidence of severe complications after LADG in the elderly was quite acceptable considering the risks associated with radical surgery with extensive lymphadenectomy. Preoperative serum concentrations of albumin (\4.0 g/dl), Roux-en-Y reconstruction, and simultaneous cholecystectomy are independent risk factors for severe postoperative complications in these patients.

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Section: Discussionsupporting

confidence: 62%

Section: Discussionmentioning

confidence: 97%

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Potentially fatal complications for elderly patients after laparoscopy-assisted distal gastrectomy

et al. 2013

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“…Recently, multi-port laparoscopic surgery (MLS) has been adopted more frequently worldwide for the treatment of colon cancer. Compared with open surgery, MLS has been associated with less pain, a quicker recovery of gastrointestinal function, improved pulmonary function, shorter hospital stays and a better postoperative quality of life (3). In addition, single-incision laparoscopic surgery (SLS) has been successfully introduced for colon cancer treatment (4)(5)(6)(7)(8), and has become a more commonly used surgical option.…”

Section: Introductionmentioning

confidence: 99%

Single-port versus multi-port laparoscopic surgery for colon cancer in elderly patients

et al. 2016

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Abstract. The safety of single-incision laparoscopic surgery (SLS) in elderly patients with colorectal cancer has not been established. The aim of the current study was to compare the outcomes of SLS and multi-port laparoscopic surgery (MLS) and to assess the feasibility of SLS in colorectal cancer patients aged ≥70 years. A retrospective case-control study of colon cancer patients undergoing elective surgical intervention between 2011 and 2014 was conducted. A total of 129 patients with colon cancer underwent surgery and were included in the analysis. Data regarding patient demographics, surgical variables, oncological outcomes and short-term outcomes were evaluated for statistical significance to compare MLS (n=79) and SLS (n=50) in colon cancer patients. No significant differences were observed in patient characteristics. No case required re-admission within 30 days post surgery. The mean surgery times were similar for the MLS and SLS groups when cases with left and right hemicolectomies were combined (207.7 and 215.9 min, respectively; P= 0.47). In addition, overall perioperative outcomes, including blood loss, number of lymph nodes harvested, size of the surgical margin and complications, were similar between these groups. Thus, we suggest that SLS can be performed safely in elderly patients with colon cancer.

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“…Yasuda et al [30] found that LADG offerred particular advantages to elderly patients (aged 70 years or more), including rapid return of gastrointestinal function, fewer complications, and a shorter hospital stay, in comparison to open surgery.…”

Section: Ladg In Obese Patients and Elderly Patientsmentioning

confidence: 99%

Laparoscopic gastrectomy with lymph node dissection for gastric cancer

2006

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surgery, including less invasiveness, less pain, earlier recovery, and better cosmesis [2]. Kitano et al. [3] first applied and described laparoscopy-assisted distal gastrectomy (LADG) as treatment for early gastric cancer (EGC) in 1994.With the development of various diagnostic modalities and the spread of mass screening, EGC now accounts for more than 50% of the total incidence of gastric cancer in Japan. The low frequency of lymph node metastasis in patients with EGC is well known; it reportedly occurs in 2%-5% of those with mucosal cancer and 11%-20% of those with submucosal cancer [4]. To allow for the treatment of EGC in patients without a risk of lymph node metastasis, laparoscopic wedge resection (LWR) with a lesion-lifting method was developed by Ohgami et al. [5] in 1992, and intragastric mucosal resection (IGMR) was developed by Ohashi [6] in the early 1990s. With the recent development of endoscopic mucosal resection (EMR) and endoscopic submucosal dissection (ESD) [7], the use of LWR and IGMR seems to be decreasing, whereas the use of LADG with lymph node dissection has increased in patients with EGC with a risk of lymph node metastasis.The past 15 years have seen remarkable advances in laparoscopic surgical techniques and instruments, such as laparoscopic coagulating shears [8]. Extended lymph node dissection (D2) and total gastrectomy can now be performed laparoscopically [9,10]. However, LADG remains controversial as a standard surgery for gastric cancer because there are few studies evaluating the technical difficulty, advantages, and oncological feasibility of LADG.Here, we review reports, in the English-language literature, of LADG with lymph node dissection as treatment for cancer, to clarify the current status of this technique and related problems. AbstractSince 1991, laparoscopic surgery has been adopted for the treatment of gastric cancer, and it has been performed worldwide, especially in Japan and Korea. We reviewed the English-language literature to clarify the current status of and problems associated with laparoscopic gastrectomy with lymph node dissection as treatment for gastric cancer. In Japan, early-stage gastric cancer (T1/T2, N0) is considered the only indication for laparoscopic gastrectomy. As yet, there is little high-level evidence based on long-term outcome supporting laparoscopic gastrectomy for cancer, but reports have provided level 3 evidence that the procedure is technically safe, and that it yields better short-term outcomes than open surgery; that is, recovery is faster, hospital stay is shorter, there is less pain, and cosmesis is better. However, investigation into the oncological outcome of laparoscopic gastrectomy as treatment for cancer is lacking. To establish laparoscopic surgery as a standard treatment for gastric cancer, multicenter randomized controlled trials to compare the short-and longterm outcomes of laparoscopic surgery versus open surgery are necessary.

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Laparoscopically assisted distal gastrectomy for early gastric cancer in the elderly

Abstract: LDG offers particular advantages to elderly patients with early gastric cancer, including rapid return of gastrointestinal function, fewer complications and a shorter hospital stay.

Cited by 78 publications

References 22 publications

Potentially fatal complications for elderly patients after laparoscopy-assisted distal gastrectomy

Potentially fatal complications for elderly patients after laparoscopy-assisted distal gastrectomy

Single-port versus multi-port laparoscopic surgery for colon cancer in elderly patients

Laparoscopic gastrectomy with lymph node dissection for gastric cancer

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