Outcomes of Laparoscopic Total Gastrectomy for Elderly Gastric Cancer Patients

Sheng, Shihou; Chen, Yahong; Liu, Chunsheng

doi:10.7150/jca.26858

Cited by 14 publications

(12 citation statements)

References 31 publications

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“…In the present study, there were no significant differences in the other short-term outcomes; thus, our surgical procedures would be considered acceptable. The only study limited to LTG showed no difference in OS or DSS (19). 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.…”

Section: Discussionmentioning

confidence: 81%

Laparoscopic Total Gastrectomy for Gastric Cancer in Elderly Patients

Suematsu

Kunisaki

Miyamato

et al. 2020

In Vivo

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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

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Section: Discussionmentioning

confidence: 81%

Laparoscopic Total Gastrectomy for Gastric Cancer in Elderly Patients

Suematsu

Kunisaki

Miyamato

et al. 2020

In Vivo

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“…Patients undergoing primary surgery are usually older and have several comorbidities, and are therefore not deemed fit enough for chemotherapy. 29 , 30 It is possible that in these patients, additional findings are more frequently detected on FDG-PET/CT or during SL, for which further diagnostics are required. Other confounding factors might also contribute to increasing waiting times.…”

Section: Discussionmentioning

confidence: 99%

Evaluation of the Implementation of FDG-PET/CT and Staging Laparoscopy for Gastric Cancer in The Netherlands

et al. 2020

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Background The role of 18F-fluorodeoxyglucose positron emission tomography with computed tomography (FDG-PET/CT) and staging laparoscopy (SL) has increased in the preoperative staging of gastric cancer. Dutch national guidelines have recommended the use of FDG-PET/CT and SL for patients with locally advanced tumors since July 2016. Objective The aim of this study was to evaluate the implementation of FDG-PET/CT and SL in The Netherlands. Methods Between 2011 and 2018, all patients who underwent surgery for gastric cancer were included from the Dutch Upper GI Cancer Audit. The use of FDG-PET/CT and SL was evaluated before and after revision of the Dutch guidelines. Outcomes included the number of non-curative procedures (e.g. palliative and futile procedures) and the association of FDG-PET/CT and SL, with waiting times from diagnosis to the start of treatment. Results A total of 3310 patients were analyzed. After July 2016, the use of FDG-PET/CT (23% vs. 61%; p < 0.001) and SL (21% vs. 58%; p < 0.001) increased. FDG-PET/CT was associated with additional waiting time to neoadjuvant therapy (4 days), as well as primary surgical treatment (20 days), and SL was associated with 8 additional days of waiting time to neoadjuvant therapy. Performing SL or both modalities consecutively in patients in whom it was indicated was not associated with the number of non-curative procedures. Conclusion During implementation of FDG-PET/CT and SL after revision of the guidelines, both have increasingly been used in The Netherlands. The addition of these staging methods was associated with increased waiting time to treatment. The number of non-curative procedures did not differ after performing none, solely one, or both staging modalities.

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“…However, LTG is more difficult due to technology than laparoscopic distal gastrectomy, reconstruction is complicated, and it has been reported that the complication rate is high in the real world[ 67 ]. It has been reported that LTG does not increase complications even in the elderly[ 68 ]; however, LTG has been reported to have anastomotic leakage[ 69 ] and complications[ 70 ]. Only well-trained laparoscopic teams should perform LTG.…”

Section: Optimal Surgical Treatment For Elderly Gcmentioning

confidence: 99%

Is surgery the best treatment for elderly gastric cancer patients?

Kawaguchi¹,

Akaike²,

Shoda³

et al. 2021

WJGS

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As the elderly population increases, the number of patients with gastric cancer has also been increasing. Elderly people have various preoperative problems such as malnutrition, high frequency of comorbidities, decreased performance status, and dementia. Furthermore, when surgery is performed, high postoperative complication rates and death from other diseases are also concerns. The goal of surgery in the elderly is that short-term outcomes are comparable to those in nonelderly, and long-term outcomes reach life expectancy. Perioperative problems in the elderly include: (1) Poor perioperative nutritional status; (2) Postoperative pneumonia; and (3) Psychological problems (dementia and postoperative delirium). Malnutrition in the elderly has been reported to be associated with increased postoperative complications and dementia, pointing out the importance of nutritional management. In addition, multidisciplinary team efforts, including perioperative respiratory rehabilitation, preoperative oral care, and early postoperative mobilization programs, are effective in preventing postoperative pneumonia. Furthermore, there are many reports on the usefulness of laparoscopic surgery for the elderly, and we considered that minimally invasive surgery would be the optimal treatment after assessing preoperative risk.

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Outcomes of Laparoscopic Total Gastrectomy for Elderly Gastric Cancer Patients

Cited by 14 publications

References 31 publications

Laparoscopic Total Gastrectomy for Gastric Cancer in Elderly Patients

Laparoscopic Total Gastrectomy for Gastric Cancer in Elderly Patients

Evaluation of the Implementation of FDG-PET/CT and Staging Laparoscopy for Gastric Cancer in The Netherlands

Is surgery the best treatment for elderly gastric cancer patients?

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