Short- and Long-Term Outcomes After Laparoscopic Versus Open Total Gastrectomy for Elderly Gastric Cancer Patients: a Propensity Score-Matched Analysis

Abstract

Background: Few studies have been designed to evaluate the short-and long-term outcomes of laparoscopy-assisted total gastrectomy (LATG), and a retrospective study of a large patient cohort is valuable before conducting randomized controlled clinical trials. Results: Among all patients, age, tumor location, histologic type, pT stage, pN stage and pTNM stage significantly differed between the LATG group and OTG group. After the propensity score matching, the clinicopathological characteristics did not significantly differ between groups. The operation time, estimated blood loss, time to first flatus and the number of retrieved lymph nodes (P < 0.05) were better in the LATG group than the OTG group. Morbidity and mortality were lower in the LATG group than the OTG group (P < 0.05) for pre-matched patients. However, significant intergroup differences in morbidity were not identified after propensity matching. Although overall survival did not significantly differ between groups for the pre-matched patients, the 3-year cumulative survival rates were significantly lower in the LATG group (89.9%) than the OTG group (97.7%) for patients with stage I disease (P = 0.028). After propensity score matching, the analysis of the cumulative survival curve did not show a significant difference for any cancer stage. Materials and Methods: We prospectively collected data from 1096 patients who underwent total gastrectomy for gastric cancer. Propensity score matching was applied to compare the covariates between the LATG group and the open total gastrectomy (OTG) group. Operative outcomes and long-term outcomes were compared between the two groups. Conclusions: Implementation of LATG for gastric cancer is a safe, reliable and minimally invasive procedure with long-term outcomes similar to those of OTG. Further randomized controlled clinical trials can be conducted to provide valuable evidence of the safety and efficacy of LATG in treating gastric cancer.

Optimal treatment for Elderly Patients with Resectable Proximal Gastric Carcinoma: A Real World Study Based on National Cancer Database

“…This finding is consistent with previous reports focusing on overall elderly patients with gastric cancer, regardless of tumor sites [17,29,30]. Moreover, the survival benefit of surgery was observed in both healthy and less healthy patients with certain comorbidities (CDCI ≥1), indicating that age-associated comorbidities should not be considered as absolute contraindication for surgery [13,31,32]. The gradually expanded indications for surgical treatment in elderly patients might attributed to the improvement of surgical techniques and postoperative intensive care treatments [33].…”

Laparoscopic total gastrectomy as a valid procedure to treat gastric cancer option both in early and advanced stage: A systematic review and meta-analysis

“…All but 2 studies contained information about LN dissection [34,39]. In the majority of studies, D2 or more extended dissection was performed, especially for studies in AGC and mixed group.…”

“…In the majority of studies, D2 or more extended dissection was performed, especially for studies in AGC and mixed group. Among studies in EGC group, D1 or extended D1 dissection was performed in 3 studies [29,33,34] and both D1þb and D2 techniques were used in one study with D2 more frequently performed in the OTG group (50.8%) compared to the LTG group (15.6%) [29].…”

“…Postoperative complications were classified into major and minor groups based on the Clavien Diendo classification in 11 studies [17,24,25,27,29,31,33,35,37,39,40]. The other seven studies did not specify complications [23,26,28,30,32,34,36]. For these seven studies, each complication was classified into major or minor complications based on other references regarding postoperative complications [44].…”

Laparoscopic vs. open distal gastrectomy for advanced gastric cancer in elderly patients: a retrospective study

“…Therefore, laparoscopic surgery may be safe even in high-risk patients. However, the operative time was longer in the LDG group than in the ODG group, and longer operative times are associated with postoperative delirium and pneumonia [26] . Our results revealed no significant differences in postoperative morbidities, suggesting that high-risk patients, including the elderly may be able to tolerate the prolonged laparoscopic operative times.…”