Safety and curability of laparoscopic gastrectomy in elderly patients with gastric cancer

Shimada, Shoji; Sawada, Naruhiko; Oae, Sonoko; Seki, Junichi; Takano, Yojiro; Ishiyama, Yasuhiro; Nakahara, Kazunari; Maeda, Chiyo; Hidaka, Eiji; Ishida, Fumio; Kudo, Shin‐ei

doi:10.1007/s00464-018-6177-1

Cited by 31 publications

(26 citation statements)

References 27 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…However, previous studies on the long-term outcomes of laparoscopic gastrectomy have reported that OS in an elderly group was poorer than that in non-elderly groups and that the DSS rates of the two groups were equivalent. In these studies, it was concluded that other causes of death affected OS in elderly patients (4)(5)(6)17). This study was compatible to previous studies.…”

Section: Discussionsupporting

confidence: 91%

Laparoscopic Total Gastrectomy for Gastric Cancer in Elderly Patients

Suematsu

Kunisaki

Miyamato

et al. 2020

In Vivo

View full text Add to dashboard Cite

Background/Aim: The purpose of this study was to evaluate the safety and efficacy of laparoscopic total gastrectomy (LTG) for elderly patients. Patients and Methods: We retrospectively analyzed 136 patients who underwent LTG. We divided the patients into elderly patients (>75 years of age) and non-elderly patients (≤75 years of age). Results: The American Society of Anesthesiologists score, Charlson comorbidity index, Glasgow Prognostic Score and rate of comorbidities were higher in the elderly group; the rates of other clinicopathological characteristics did not differ between the two groups. Regarding the nutritional status, the body weight loss rate in the elderly group was higher in comparison to the non-elderly group (81% vs. 84%, p=0.004). The disease-specific survival (DSS) did not differ between two groups to a statistically significant extent (3-year DSS rates: 83.7 vs. 94.5%; p=0.152). Conclusions: LTG was acceptable for elderly patients as the elderly and non-elderly groups showed comparable shortterm and long-term outcomes. In recent years, the aging of the global population is progressing, and the prolongation of life expectancy in Japan has been remarkable. Elderly people (≥65 years of age) account for more than 25% of the Japanese population, and are expected to account for 40% of the population in 2060 (1). Thus, the number of elderly gastric cancer patients is expected to increase, and it is necessary to evaluate appropriate therapeutic strategies for elderly patients. Generally, these patients have various comorbidities including cardiovascular and respiratory diseases (2-6), thus, minimally invasive treatment is mandatory. Since it was reported by Kitano et al. (7), laparoscopic distal gastrectomy (LDG) has been widely performed in Japan and East Asian countries in recent years as a minimally invasive operation for gastric cancer. Laparoscopic total gastrectomy (LTG) is also being performed for gastric cancer that is mainly located in the upper third of the stomach (8-10). However, LTG has not been regarded as a standard procedure for early gastric cancer due to its technical difficulties and the complexity of reconstruction; thus, this is not listed in the Japanese Gastric Cancer Treatments Guidelines (11). Recently, several studies on LTG in gastric cancer patients have reported favorable short-term and long-term outcomes in comparison to open surgery (12-14). However, the surgical safety and efficacy and oncological usefulness of LTG for elderly patients is still unclear. Thus, this study aimed to clarify the safety and efficacy of LTG for elderly patients with gastric cancer. Patients and Methods Patients. We retrospectively analyzed 136 patients with gastric cancer that was mainly located in the upper third of the stomach, who underwent no residual tumor (R0) resection LTG with regional lymph node dissection at the

show abstract

Section: Discussionsupporting

confidence: 91%

Laparoscopic Total Gastrectomy for Gastric Cancer in Elderly Patients

Suematsu

Kunisaki

Miyamato

et al. 2020

In Vivo

View full text Add to dashboard Cite

show abstract

“…In this study, multivariate analysis showed that extended operation time was an independent risk factor for the occurrence of severe complications in the elderly group. Additionally, LG was not identified as a risk factor for overall and severe complications, which is similar to the previous studies comparing the clinical outcomes of LG and OG for elderly gastric-cancer patients [ 20 , 38 ].…”

Section: Discussionsupporting

confidence: 87%

“…Regarding the effect of survival in elderly patients, Zheng et al [ 41 ] reported similar 2-year OS rates between the LG and OG groups. Shimada et al [ 20 ] demonstrated that LG could be a curative therapy procedure for elderly gastric-cancer patients in the comparison of 5-year DSS rates between elderly and non-elderly groups. In the current study, the 5-year OS rate of patients in the ELG group was lower than that in the NLG group.…”

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

Laparoscopic gastrectomy for elderly gastric-cancer patients: comparisons with laparoscopic gastrectomy in non-elderly patients and open gastrectomy in the elderly

Chen

Bai

et al. 2020

Gastroenterology Report

View full text Add to dashboard Cite

Background The benefits of laparoscopic gastrectomy (LG) in elderly gastric-cancer patients still remain unclear. The purpose of this study was to evaluate the feasibility and safety of LG in elderly gastric-cancer patients. Methods We retrospectively evaluated patients who underwent LG or open gastrectomy (OG) between June 2009 and July 2015 in a single high-volume center. We compared surgical, short-term, and long-term survival outcomes among an elderly (≥70 years old) LG (ELG) group (n = 114), a non-elderly (<70 years old) LG (NLG) group (n = 740), and an elderly OG (EOG) group (n = 383). Results Except for extended time to first flatus, the surgical and short-term outcomes of the ELG group were similar to those of the NLG group. The ELG group revealed comparable disease-specific survival (DSS) rates to the NLG group (64.9% vs 66.2%, P = 0.476), although the overall survival (OS) rate was lower (57.0% vs 65.5%, P < 0.001) in the ELG group than in the NLG group. The ELG group showed longer operation time than the EOG group (236.4 ± 77.3 vs 179 ± 52.2 min, P < 0.001). The ELG group had less estimated blood loss (174.0 ± 88.4 vs 209.3 ± 133.8, P = 0.008) and shorter post-operative hospital stay (8.3 ± 2.5 vs 9.2 ± 4.5, P = 0.048) than the EOG group. The severity of complications was similar between the ELG and NLG groups. Multivariate analysis confirmed that LG was not a risk factor for post-operative complications. Conclusions LG is a feasible and safe procedure for elderly patients with acceptable short- and long-term survival outcomes.

show abstract

“…The main reason is the higher prevalence of cardiac, pulmonary and other comorbidities in older patients [8,9]. 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].…”

Section: Introductionmentioning

confidence: 99%

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

et al. 2018

View full text Add to dashboard Cite

Background Laparoscopic gastrectomy (LG) might have greater clinical benefits for elderly patients as less invasive surgery; however, there is still little evidence to support its benefit. We evaluated the surgical outcomes of elderly patients in a nationwide prospective cohort study. Methods One hundred and sixty-nine participating institutions were identified by stratified random sampling, and were adjusted for hospital volume, type and location. During 1 year from 2014 to 2015, consecutive patients who underwent gastrectomy for gastric cancer were prospectively enrolled. 'Elderly' was defined as ≥ 75 years of age, based on the prevalence of comorbidities and the activities of daily living of patients of this age. We compared the surgical outcomes of LG to those of open gastrectomy (OG) in non-elderly and elderly patients. The primary outcome was the incidence of severe morbidities (Grade ≥ 3). Results Eight thousand nine hundred and twenty-seven patients were enrolled [non-elderly, n = 6090 (OG, n = 2602; LG, n = 3488); elderly, n = 2837 (OG, n = 1471; LG, n = 1366)]. Grade ≥ 3 complications occurred in 161 (10.9%) patients who underwent OG and 98 (7.2%) who underwent LG (p < 0.001). After adjusting for confounding factors, we confirmed that laparoscopic surgery was not an independent risk factor (odds ratio = 0.81, 0.60-1.09). OG was associated with a significantly longer median length of postoperative stay in comparison to LG (16 versus 12 days, p < 0.001). There were no significant differences in the incidence of other postoperative comorbidities. Conclusion The safety of LG in elderly patients was demonstrated.LG shortened the length of postoperative hospital stay.

show abstract

Safety and curability of laparoscopic gastrectomy in elderly patients with gastric cancer

Abstract: Laparoscopic gastrectomy for gastric cancer could be safely performed in elderly patients with acceptable postoperative morbidity and curability.

Cited by 31 publications

References 27 publications

Laparoscopic Total Gastrectomy for Gastric Cancer in Elderly Patients

Laparoscopic Total Gastrectomy for Gastric Cancer in Elderly Patients

Laparoscopic gastrectomy for elderly gastric-cancer patients: comparisons with laparoscopic gastrectomy in non-elderly patients and open gastrectomy in the elderly

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

Contact Info

Product

Resources

About