Safety of Laparoscopy-assisted Distal Gastrectomy in Patients Aged 75 Years or More

Abstract

To determine whether Laparoscopy-Assisted Distal Gastrectomy (LADG) is suitable for treatment of gastric cancer in elderly patients, we conducted a retrospective study to examine the safety and outcomes of LADG performed in elderly patients at our hospital. Patients and Methods: Included in the study were 68 patients (15 aged ≥75 years and 53 aged <75 years) who underwent LADG at our hospital. We compared patients' characteristics (age, sex, and body mass index [BMI]), physical status as defined by the American Society of Anesthesiologists (ASA-PS), medical history, whether endoscopic submucosal dissection (ESD) had been performed previously; surgical factors (operation time, blood loss volume, length of hospital stay, extent of dissection, number of lymph nodes dissected, anastomosis method, time to first flatus, time to first stool, complications); and pathologic factors (tumor location, tumor presence, invasion depth, lymph node metastasis). Results: Mean age of the elderly patients was 79.8 years (75-86 years). Mean BMI was 18.4 (14.3-22.2) kg/m 2 . Three elderly patients were classified into ASA-PS 3, and hypertension was common in the elderly group. The mean duration of surgery was 193.2 (125-290) minutes, and the mean blood loss volume was 52 (4-263) mL. Mean time to first flatus and first stool were 3.0 (2-5) days and 5.3 (4-8) days, respectively. The mean hospital stay was 18.4 (8-48) days. Complications included 1 pancreatic fistula and 1 stenosis associated with an anastomotic ulcer. The mean number of lymph nodes dissected was 33.1 (15-61), and there were 3 cases of lymph node metastasis. Only BMI and the incidence of previous ESD differed between the elderly patients and younger patients. Conclusion:We conclude on the basis of our study findings that laparoscopy-assisted distal gastrectomy can be perfomed safely in patients aged 75 years and older (just as it is in patients under 75 years of age), as long as patient selection is properly carried out.