Department of Surgery and Oncology, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan.
Asian J Endosc Surg. 2021 Jul;14(3):408-416. doi: 10.1111/ases.12883. Epub 2020 Nov 3.
The proportion of patients aged 75 years and over who undergo minimally invasive surgery for gastric cancer is increasing. However, the safety and feasibility of laparoscopic gastrectomy (LG) in this age group is controversial. This study aimed to evaluate whether LG is safe and effective in patients aged 75 years and over.
The study included 728 patients with early and advanced gastric cancer who underwent curative LG between 2009 and 2017; 166 of these patients (22.8%) were aged 75 or over. All surgeries were performed laparoscopically. Selected clinical factors were compared between the 166 patients aged 75 years and over and the 562 patients aged under 75 years.
There were significant differences in presence of comorbidity, respiratory function and American Society of Anesthesiologists physical status scores between the older and younger groups. The older patients more frequently developed complications than the younger ones, particularly postoperative pneumonia. According to multivariate analyses of all participants, age, chronic obstructive pulmonary disease (COPD), and D2 lymphadenectomy were independent risk factors for postoperative pneumonia. Advanced stage and D2 lymphadenectomy were independent risk factors in the older group, whereas only COPD was an independent risk factor in the younger group.
LG for gastric cancer can be safely performed in patients aged over 75 years with an acceptable complication rate. However, the present data suggest that care should be taken in selecting LG with D2 lymphadenectomy to treat advanced cancer in these patients because the risk of postoperative complications, especially postoperative pneumonia, increases.
接受胃癌微创手术治疗的 75 岁及以上患者比例正在增加。然而，在该年龄组中实施腹腔镜胃切除术（LG）的安全性和可行性仍存在争议。本研究旨在评估 LG 对 75 岁及以上患者是否安全有效。
本研究纳入了 2009 年至 2017 年间接受根治性 LG 治疗的早期和进展期胃癌患者 728 例，其中 166 例（22.8%）患者年龄在 75 岁及以上。所有手术均通过腹腔镜进行。比较了 166 例年龄 75 岁及以上患者和 562 例年龄 75 岁以下患者的选定临床因素。
两组患者在合并症、呼吸功能和美国麻醉医师协会身体状况评分方面存在显著差异。老年组患者比年轻组患者更常发生并发症，尤其是术后肺炎。根据所有患者的多因素分析，年龄、慢性阻塞性肺疾病（COPD）和 D2 淋巴结清扫术是术后肺炎的独立危险因素。在老年组中，晚期疾病和 D2 淋巴结清扫术是独立危险因素，而在年轻组中，只有 COPD 是独立危险因素。
LG 治疗 75 岁以上胃癌患者是安全的，并发症发生率可接受。然而，目前的数据表明，在选择 D2 淋巴结清扫术治疗这些患者的晚期癌症时应谨慎，因为术后并发症（尤其是术后肺炎）的风险会增加。
