Hikage Makoto, Fujiya Keiichi, Kamiya Satoshi, Tanizawa Yutaka, Bando Etsuro, Terashima Masanori
Division of Gastric Surgery, Shizuoka Cancer Center, 1007 Shimonagakubo, Nagaizumi-cho, Sunto-gun, Shizuoka, 411-8777, Japan.
Surg Endosc. 2021 Dec;35(12):7082-7093. doi: 10.1007/s00464-020-08224-w. Epub 2021 Mar 23.
Phase III trials have shown the non-inferiority of minimally invasive distal gastrectomy (MIDG) comparison with open distal gastrectomy (ODG) in patients with gastric cancer; however, it remains unclear whether MIDG is also effective in the elderly. This study aimed to clarify the efficacy of MIDG in elderly gastric cancer patients.
This study included 316 patients older than 75 years with clinical stage I/IIA gastric cancer who underwent distal gastrectomy from August 2008 to December 2016 at the Shizuoka Cancer Centre. The long-term outcomes between MIDG and ODG were compared after propensity score matching.
After propensity score matching, there were 97 patients each in the MIDG and ODG groups, with an improved balance of confounding factors between the two groups. MIDG was associated with significantly longer operative time and a lower level of blood loss than ODG. The incidence of complications was comparable between the two groups. Survival outcomes were better in the MIDG group than in the ODG group (overall survival; P = 0.034, relapse-free survival; P = 0.027). In the multivariable analysis, ODG [hazard ratio (HR) 1.971, P = 0.046], being 80 years or older (HR 2.285, P = 0.018), male sex (HR 2.428, 95% P = 0.024), and poor physical status (HR 2.324, P = 0.022) were identified as independent prognostic factors for overall survival.
We found that MIDG showed better efficacy than ODG in elderly gastric cancer patients. MIDG is an acceptable option for elderly patients.
III期试验已表明，在胃癌患者中，微创远端胃切除术（MIDG）与开放远端胃切除术（ODG）相比具有非劣效性；然而，MIDG在老年患者中是否同样有效仍不清楚。本研究旨在阐明MIDG在老年胃癌患者中的疗效。
本研究纳入了2008年8月至2016年12月在静冈癌症中心接受远端胃切除术的316例年龄大于75岁的临床I/IIA期胃癌患者。在倾向评分匹配后，比较了MIDG和ODG的长期结局。
倾向评分匹配后，MIDG组和ODG组各有97例患者，两组间混杂因素的平衡得到改善。与ODG相比，MIDG的手术时间显著更长，失血量更低。两组间并发症发生率相当。MIDG组的生存结局优于ODG组（总生存期；P = 0.034，无复发生存期；P = 0.027）。在多变量分析中，ODG（风险比[HR] 1.971，P = 0.046）、年龄80岁及以上（HR 2.285，P = 0.018）、男性（HR 2.428，95% P = 0.024）和身体状况差（HR 2.324，P = 0.022）被确定为总生存期的独立预后因素。
我们发现，在老年胃癌患者中，MIDG的疗效优于ODG。MIDG是老年患者可接受的选择。
