Digestive Disease Center, Showa University Northern Yokohama Hospital, 35-1, Chigasaki-Chuo Tsuzuki-ku, Yokohama, 224-8503, Japan.
Surg Endosc. 2018 Oct;32(10):4277-4283. doi: 10.1007/s00464-018-6177-1. Epub 2018 Mar 30.
Elderly patients are often considered as a high-risk population for major abdominal surgery due to reduced functional reserve and increased comorbidities. The aim of this study was to assess the safety and curability of laparoscopic gastrectomy in elderly patients with gastric cancer compared with short- and long-term outcomes in non-elderly patients.
We retrospectively investigated 386 patients who underwent laparoscopic gastrectomy for gastric cancer between January 2007 and December 2015 at the Digestive Disease Center, Showa University, Northern Yokohama Hospital. We categorized the patients into two groups by age: the elderly patients (≥ 75 years old) and the non-elderly patients (< 74 years old). Patient characteristics, clinicopathologic and operative findings, and short- and long-term outcomes were investigated and compared between the two groups.
The elderly group showed a significantly higher rate of comorbidities (73.1 vs. 49.2%, P < 0.001), and American Society of Anesthesiologists (ASA) scores ≥ 2 (76.3 vs. 43.7%, P < 0.001), and using anticoagulant agents (25.8 vs. 7.9%, P < 0.001) than the non-elderly group. The postoperative morbidity and mortality did not differ between the two groups (19.4 vs. 18.8%; P = 0.880, 2.2 vs. 0%; P = 0.058). In the multivariate analysis, male sex was the only risk factor for postoperative morbidity after laparoscopic gastrectomy. However, age was not found to be a risk factor. The 5-year overall survival ratio was significantly lower in the elderly group than in the non-elderly group (67.7 vs. 85.0%; P < 0.001). However, the 5-year disease-specific survival ratio was similar in the two groups (84.8 vs. 89.1%; P = 0.071).
Laparoscopic gastrectomy for gastric cancer could be safely performed in elderly patients with acceptable postoperative morbidity and curability.
老年患者由于功能储备减少和合并症增加，常被认为是大腹部手术的高危人群。本研究旨在评估与非老年患者相比，腹腔镜胃癌手术在老年胃癌患者中的安全性和可治愈性，并比较其短期和长期结果。
我们回顾性调查了 2007 年 1 月至 2015 年 12 月在昭和大学北方横浜医院消化疾病中心接受腹腔镜胃癌手术的 386 名患者。我们根据年龄将患者分为两组：老年患者（≥75 岁）和非老年患者（<74 岁）。调查并比较了两组患者的临床病理和手术发现以及短期和长期结果。
老年组的合并症发生率（73.1%比 49.2%，P<0.001）、美国麻醉医师协会（ASA）评分≥2（76.3%比 43.7%，P<0.001）和使用抗凝剂的比例（25.8%比 7.9%，P<0.001）均显著高于非老年组。两组术后发病率和死亡率无差异（19.4%比 18.8%；P=0.880，2.2%比 0%；P=0.058）。多因素分析显示，男性是腹腔镜胃癌手术后发病率的唯一危险因素。然而，年龄不是危险因素。老年组的 5 年总生存率明显低于非老年组（67.7%比 85.0%；P<0.001）。然而，两组的 5 年疾病特异性生存率相似（84.8%比 89.1%；P=0.071）。
腹腔镜胃癌手术在老年胃癌患者中是安全可行的，术后发病率和可治愈性可接受。
