Jung Hong Sung, Park Young Kyu, Ryu Seong Yeob, Jeong Oh
Division of Gastroenterological Surgery, Department of Surgery, Chonnam National University Hwasun Hospital, Hwasun, Korea.
J Gastric Cancer. 2015 Sep;15(3):176-82. doi: 10.5230/jgc.2015.15.3.176. Epub 2015 Sep 30.
To compare the surgical outcomes of laparoscopic total gastrectomy between elderly and non-elderly patients.
Between 2008 and 2015, a total of 273 patients undergoing laparoscopic total gastrectomy for gastric carcinoma were divided into two age groups: elderly (≥70 years, n=71) vs. non-elderly (<70 years, n=172). Postoperative outcomes, including length of hospital stay, morbidity, and mortality were compared between the groups.
The elderly group showed a significantly higher rate of comorbidities and American Society of Anesthesiologists scores than those in the non-elderly group. No significant differences were found with respect to lymphadenectomy or combined organ resection between the groups. After surgery, the elderly group showed a significantly higher incidence of grade III and above complications than the non-elderly group (15.5% vs. 4.1%, P=0.003). Among the complications, anastomosis leakage was significantly more common in the elderly group (9.9% vs. 2.9%, P=0.044). Univariate and multivariate analyses showed that old age (≥70 years) was an independent risk factor (odds ratio=4.42, 95% confidence interval=1.50~13.01) for postoperative complications of grade III and above.
Elderly patients are more vulnerable to grade III and above complications after laparoscopic total gastrectomy than non-elderly patients. Great care should be taken to prevent and monitor the development of anastomosis leakage in elderly patients after laparoscopic total gastrectomy.
比较老年和非老年患者腹腔镜全胃切除术的手术效果。
2008年至2015年期间，共有273例因胃癌接受腹腔镜全胃切除术的患者被分为两个年龄组：老年组（≥70岁，n = 71）和非老年组（<70岁，n = 172）。比较两组患者的术后结果，包括住院时间、发病率和死亡率。
老年组的合并症发生率和美国麻醉医师协会评分显著高于非老年组。两组在淋巴结清扫或联合器官切除方面未发现显著差异。术后，老年组III级及以上并发症的发生率显著高于非老年组（15.5%对4.1%，P = 0.003）。在并发症中，吻合口漏在老年组中明显更常见（9.9%对2.9%，P = 0.044）。单因素和多因素分析表明，年龄≥70岁是术后III级及以上并发症的独立危险因素（比值比 = 4.42，95%置信区间 = 1.50~13.01）。
与非老年患者相比，老年患者在腹腔镜全胃切除术后更容易发生III级及以上并发症。在老年患者腹腔镜全胃切除术后，应格外小心预防和监测吻合口漏的发生。
