Li Zheng-Yan, Chen Jie, Bai Bin, Xu Shuai, Song Dan, Lian Bo, Li Ji-Peng, Ji Gang, Zhao Qing-Chuan
Xijing Hospital of Digestive Diseases, Fourth Military Medical University, Xi'an, Shanxi, P. R. China.
Department of General Surgery, Southwest Hospital, Third Military Medical University, Chongqing, P. R. China.
Gastroenterol Rep (Oxf). 2020 Sep 10;9(2):146-153. doi: 10.1093/gastro/goaa041. eCollection 2021 Apr.
The benefits of laparoscopic gastrectomy (LG) in elderly gastric-cancer patients still remain unclear. The purpose of this study was to evaluate the feasibility and safety of LG in elderly gastric-cancer patients.
We retrospectively evaluated patients who underwent LG or open gastrectomy (OG) between June 2009 and July 2015 in a single high-volume center. We compared surgical, short-term, and long-term survival outcomes among an elderly (≥70 years old) LG (ELG) group (=114), a non-elderly (<70 years old) LG (NLG) group (=740), and an elderly OG (EOG) group (=383).
Except for extended time to first flatus, the surgical and short-term outcomes of the ELG group were similar to those of the NLG group. The ELG group revealed comparable disease-specific survival (DSS) rates to the NLG group (64.9% vs 66.2%, =0.476), although the overall survival (OS) rate was lower (57.0% vs 65.5%, <0.001) in the ELG group than in the NLG group. The ELG group showed longer operation time than the EOG group (236.4 ± 77.3 vs 179 ± 52.2 min, <0.001). The ELG group had less estimated blood loss (174.0 ± 88.4 vs 209.3 ± 133.8, =0.008) and shorter post-operative hospital stay (8.3 ± 2.5 vs 9.2 ± 4.5, =0.048) than the EOG group. The severity of complications was similar between the ELG and NLG groups. Multivariate analysis confirmed that LG was not a risk factor for post-operative complications.
LG is a feasible and safe procedure for elderly patients with acceptable short- and long-term survival outcomes.
腹腔镜胃切除术（LG）在老年胃癌患者中的益处仍不明确。本研究的目的是评估LG在老年胃癌患者中的可行性和安全性。
我们回顾性评估了2009年6月至2015年7月期间在一个高容量单一中心接受LG或开腹胃切除术（OG）的患者。我们比较了老年（≥70岁）LG（ELG）组（=114）、非老年（<70岁）LG（NLG）组（=740）和老年OG（EOG）组（=383）之间的手术、短期和长期生存结果。
除首次排气时间延长外，ELG组的手术和短期结果与NLG组相似。ELG组的疾病特异性生存率（DSS）与NLG组相当（64.9%对66.2%，=0.476），尽管ELG组的总生存率（OS）低于NLG组（57.0%对65.5%，<0.001）。ELG组的手术时间比EOG组长（236.4±77.3对179±52.2分钟，<0.001）。ELG组的估计失血量少于EOG组（174.0±88.4对209.3±133.8，=（此处原文有误，推测应为<）0.008），术后住院时间也短于EOG组（8.3±2.5对9.2±4.5，=0.048）。ELG组和NLG组并发症的严重程度相似。多因素分析证实LG不是术后并发症的危险因素。
LG对于老年患者是一种可行且安全的手术，具有可接受的短期和长期生存结果。
