Kim Dong Jin, Kim Wook
Department of Surgery, The Catholic University of Korea St. Paul's Hospital, The Catholic University of Korea College of Medicine, Seoul, Korea.
Division of Gastrointestinal Surgery, Department of Surgery, The Catholic University of Korea Yeouido St. Mary's Hospital, The Catholic University of Korea College of Medicine, Seoul, Korea.
J Gastric Cancer. 2018 Jun;18(2):109-117. doi: 10.5230/jgc.2018.18.e11. Epub 2018 Apr 24.
This study aimed to investigate the outcomes of laparoscopic gastrectomy in very elderly patients with gastric cancer, who have outlived the average lifespan of the Korean population (men: ≥77 years, women: ≥84 years).
Between 2004 and 2015, 836 patients with gastric cancer underwent a laparoscopic gastrectomy. They were divided into the elderly group (EldG) and non-elderly group (nEldG). Propensity score matching for covariates of sex, tumor depth, node status, and extent of resection was performed. Clinicopathologic characteristics, and surgical and survival outcomes were compared between the 2 groups.
The EldG had a higher American Society of Anesthesiologists (ASA) score and a higher number of comorbidities. There was no significant difference in the post-operative complications, except for pulmonary complications, which were more frequent in the EldG (5/56, 8.9%) than in the nEldG (0/56, 0%). The EldG had a shorter overall survival (OS), but cancer-specific survival was similar for both groups. Among deceased patients, 2 (25%) and 8 patients (50%) died within a year of surgery in the nEldG and EldG, respectively. Univariate and multivariate risk factor analyses for OS showed that age, ASA score, tumor, node, metastasis (TNM) stage, and occurrence of complications were significantly related to deterioration in OS.
Laparoscopic gastrectomy can be safely performed in very elderly patients with gastric cancer who have outlived the average lifespan of the Korean population. However, impact of laparoscopic gastrectomy on improving survival is not clear, and careful patient selection is recommended.
本研究旨在调查年龄超过韩国人口平均寿命（男性：≥77岁，女性：≥84岁）的老年胃癌患者行腹腔镜胃切除术的疗效。
2004年至2015年间，836例胃癌患者接受了腹腔镜胃切除术。他们被分为老年组（EldG）和非老年组（nEldG）。对性别、肿瘤深度、淋巴结状态和切除范围等协变量进行倾向评分匹配。比较两组的临床病理特征、手术及生存结果。
老年组美国麻醉医师协会（ASA）评分更高，合并症数量更多。除肺部并发症外，两组术后并发症无显著差异，老年组肺部并发症发生率（5/56，8.9%）高于非老年组（0/56，0%）。老年组总生存期（OS）较短，但两组癌症特异性生存期相似。在死亡患者中，非老年组和老年组分别有2例（25%）和8例（50%）在术后1年内死亡。对总生存期的单因素和多因素风险因素分析显示，年龄、ASA评分、肿瘤、淋巴结、转移（TNM）分期及并发症的发生与总生存期恶化显著相关。
对于年龄超过韩国人口平均寿命的老年胃癌患者，可安全地实施腹腔镜胃切除术。然而，腹腔镜胃切除术对提高生存率的影响尚不清楚，建议谨慎选择患者。
