Kosuga Toshiyuki, Ichikawa Daisuke, Okamoto Kazuma, Komatsu Shuhei, Konishi Hirotaka, Takeshita Hiroki, Shiozaki Atsushi, Fujiwara Hitoshi, Morimura Ryo, Ikoma Hisashi, Murayama Yasutoshi, Kuriu Yoshiaki, Nakanishi Masayoshi, Sakakura Chouhei, Otsuji Eigo
Division of Digestive Surgery, Department of Surgery, Kyoto Prefectural University of Medicine, Kyoto, Japan.
Division of Digestive Surgery, Department of Surgery, Kyoto Prefectural University of Medicine, Kyoto, Japan
Anticancer Res. 2015 Apr;35(4):2191-8.
BACKGROUND/AIM: Although laparoscopy-assisted gastrectomy (LAG) is widely used for the treatment of gastric cancer, its safety and feasibility for elderly patients remains controversial. We herein examined the impact of age on the early surgical outcomes of LAG with suprapancreatic nodal dissection for elderly patients with clinical stage I gastric cancer.
This retrospective study included 292 patients undergoing LAG with suprapancreatic nodal dissection for clinical stage I gastric cancer. We divided patients into an elderly group (age ≥ 75 years; n=55) and non-elderly group (age <75 years; n=237). Preoperative conditions, operative findings and postoperative outcomes, including complications, were compared between these two groups.
The elderly group had a higher incidence of co-morbidities (61.8%) and lower forced expiratory volume in 1 second/forced vital capacity (74.8%). Preoperative levels of hemoglobin (Hb) and serum albumin (Alb), as well as the total lymphocyte count (TLC) were lower in the elderly group (p<0.001, <0.001 and =0.018, respectively). No significant differences were observed in intraoperative findings between the two groups. The incidence of overall and surgical complications in the elderly group (21.8% and 14.5%, respectively) did not significantly differ from those in the non-elderly group. The frequency of non-surgical complications in the elderly group (9.1%) was significantly higher (p =0.018), whereas no critical complications or mortality were observed. No significant differences were noted in the severity of complications or hospital courses between the groups.
LAG with suprapancreatic nodal dissection appears to be safe and feasible for elderly patients with clinical stage I gastric cancer.
背景/目的：尽管腹腔镜辅助胃切除术（LAG）广泛应用于胃癌治疗，但其对老年患者的安全性和可行性仍存在争议。我们在此研究了年龄对临床I期老年胃癌患者行LAG联合胰上淋巴结清扫术早期手术结局的影响。
这项回顾性研究纳入了292例行LAG联合胰上淋巴结清扫术治疗临床I期胃癌的患者。我们将患者分为老年组（年龄≥75岁；n = 55）和非老年组（年龄<75岁；n = 237）。比较两组患者的术前情况、手术发现及术后结局，包括并发症。
老年组合并症发生率较高（61.8%），第一秒用力呼气量/用力肺活量较低（74.8%）。老年组术前血红蛋白（Hb）、血清白蛋白（Alb）水平以及总淋巴细胞计数（TLC）较低（分别为p<0.001、<0.001和=0.018）。两组术中发现无显著差异。老年组总体并发症和手术并发症的发生率（分别为21.8%和14.5%）与非老年组无显著差异。老年组非手术并发症的发生率（9.1%）显著更高（p = 0.018），但未观察到严重并发症或死亡病例。两组间并发症严重程度及住院病程无显著差异。
对于临床I期老年胃癌患者，LAG联合胰上淋巴结清扫术似乎是安全可行的。
