腹腔镜胃癌手术治疗≥80 岁老年患者的技术与肿瘤安全性。
Technical and oncological safety of laparoscopic gastrectomy for gastric cancer in elderly patients ≥ 80 years old.
机构信息
Department of Comprehensive Surgery for Community Medicine, Oita University Faculty of Medicine, Hasama-machi, Oita, 879-5593, Japan.
Department of Gastroenterological and Pediatric Surgery, Oita University Faculty of Medicine, Oita, Japan.
出版信息
BMC Geriatr. 2022 Jun 2;22(1):475. doi: 10.1186/s12877-022-03180-7.
BACKGROUND
As the incidence of gastric cancer increases in elderly patients worldwide, laparoscopic gastrectomy (LG) for elderly patients with gastric cancer is also increasing. However, whether LG is an optimal surgical modality for elderly patients with gastric cancer remains unclear. This study aimed to evaluate the technical and oncological safety of LG for elderly patients ≥ 80 years old with gastric cancer.
METHODS
Patients who received curative gastrectomy for gastric cancer from 2003 to 2015 were enrolled in the study. They were divided into the LG in elderly patients aged over 80 years (LG-E) group, open gastrectomy (OG) in elderly patients (OG-E) group, and LG in non-elderly patients < 80 years (LG-NE) group. Patients' demographics and short- and long-term outcomes, such as postoperative complications and 5-year survival rate, were compared between the three groups, retrospectively.
RESULTS
The LG-E, OG-E, and LG-NE groups comprised 45, 43, and 329 patients, respectively. In the comparison between the LG-E and OG-E groups, the incidence of distal gastrectomy (DG) and the proportions of patients with pathological tumor stage T1, pathological N0, and final stage I were significantly higher in the LG-E versus OG-E group (89 vs. 56%, 76% vs. 16%, 82% vs. 37%, and 84% vs. 35%, p < 0.01, respectively). Blood loss and the incidence of overall postoperative complications in the LG-E group were significantly lower than those in the OG-E group (40 vs. 240 g, p < 0.01, and 29% vs. 53%, p < 0.05, respectively). Although the 5-year overall survival (OS) rate was not significantly different between the two groups, the 5-year disease-specific survival (DSS) rate was significantly higher in the LG-E group versus OG-E group (93% vs. 78%, p < 0.05). Overall comorbidities were significantly higher in the LG-E group versus LG-NE group, but there were no significant differences in short-term outcomes between the two groups. Further, although the 5-year OS rate was significantly lower in the LG-E group versus LG-NE group (67% vs. 87%, p < 0.01), there was no significant difference between the two groups in 5-year DSS rate.
CONCLUSION
LG is technically and oncologically safe for the treatment of gastric cancer in both elderly patients aged ≥ 80 years and the non-elderly and can be an optimal surgical modality for elderly patients with gastric cancer.
背景
随着全球老年胃癌患者发病率的增加，腹腔镜胃癌切除术（LG）在老年胃癌患者中的应用也在增加。然而，LG 是否是老年胃癌患者的最佳手术方式仍不清楚。本研究旨在评估 LG 治疗 80 岁以上老年胃癌患者的技术和肿瘤学安全性。
方法
本研究纳入了 2003 年至 2015 年期间接受胃癌根治性切除术的患者。他们被分为 LG 治疗 80 岁以上老年患者（LG-E）组、OG 治疗 80 岁以上老年患者（OG-E）组和 LG 治疗＜80 岁非老年患者（LG-NE）组。回顾性比较三组患者的术后并发症和 5 年生存率等短期和长期结局。
结果
LG-E、OG-E 和 LG-NE 组分别包括 45、43 和 329 例患者。LG-E 与 OG-E 组相比，远端胃癌（DG）的发生率、病理 T1 期、病理 N0 期和最终 I 期患者的比例显著更高（89%比 56%、76%比 16%、82%比 37%和 84%比 35%，p<0.01）。LG-E 组术中出血量和总术后并发症发生率显著低于 OG-E 组（40 比 240g，p<0.01；29%比 53%，p<0.05）。两组患者 5 年总生存率（OS）无显著差异，但 LG-E 组患者 5 年疾病特异性生存率（DSS）显著高于 OG-E 组（93%比 78%，p<0.05）。LG-E 组患者总体合并症显著高于 LG-NE 组，但两组患者短期结局无显著差异。此外，尽管 LG-E 组患者 5 年 OS 率显著低于 LG-NE 组（67%比 87%，p<0.01），但两组患者 5 年 DSS 率无显著差异。
结论
LG 治疗 80 岁以上老年胃癌患者和非老年患者在技术和肿瘤学上都是安全的，是老年胃癌患者的一种理想手术方式。
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