Department of Surgery, Teikyo University Hospital, Mizonokuchi, Kawasaki, Japan.
Jpn J Clin Oncol. 2022 Nov 3;52(11):1282-1288. doi: 10.1093/jjco/hyac126.
It remains unclear whether laparoscopic gastrectomy with optimal lymphadenectomy is appropriate for very elderly patients with advanced gastric cancer. This study aimed to assess the validity of laparoscopic gastrectomy with D1+ lymphadenectomy performed for advanced gastric cancer in patients aged 80 years or more.
Included in this retrospective study were 122 patients who underwent curative laparoscopic gastrectomy for advanced gastric cancer between 2013 and 2018. All patients over 80 years old underwent laparoscopic gastrectomy with D1+ lymphadenectomy. We divided patients by age between those who were very elderly (age ≥ 80 years; very elderly group [n = 57]) and those who were non-very elderly (age < 80 years; control group [n = 65]), and we compared patient and clinicopathological characteristics, intraoperative outcomes, and short- and long-term outcomes between the two groups. We also performed multivariate analyses to identify predictors of postoperative prognosis.
Eastern Cooperative Oncology Group Performance Status of grade 2 or higher and mean Charlson comorbidity index score and body mass index were significantly different between the very elderly group and the control group. Adjuvant chemotherapy was used in relatively few very elderly group patients. Operation time, blood loss volume, and postoperative morbidity and mortality did not differ between the two groups. The overall survival and disease-specific survival rate of very elderly group patients with the Charlson comorbidity index score of <3 was not significantly different from that of the control group patients.
The treatment of advanced gastric cancer by laparoscopic gastrectomy with D1+ lymphadenectomy to be both safe and effective in the very elderly group patients with the Charlson comorbidity index score of <3.
腹腔镜根治性淋巴结清扫术治疗高龄局部进展期胃癌的疗效仍存在争议。本研究旨在评估腹腔镜 D1+淋巴结清扫术治疗 80 岁以上局部进展期胃癌的安全性和有效性。
回顾性分析 2013 年 1 月至 2018 年 1 月行腹腔镜胃癌根治术的 122 例局部进展期胃癌患者的临床资料。所有 80 岁以上患者均行腹腔镜 D1+淋巴结清扫术。根据年龄将患者分为高龄组（年龄≥80 岁，n=57）和非高龄组（年龄<80 岁，n=65），比较两组患者的临床病理特征、术中及术后情况，并采用多因素分析探讨影响患者术后预后的因素。
高龄组患者的美国东部肿瘤协作组体力状况评分≥2 分、Charlson 合并症指数评分和体质量指数均显著高于非高龄组。高龄组患者术后接受辅助化疗的比例显著低于非高龄组。两组患者的手术时间、术中出血量、术后并发症发生率及死亡率差异均无统计学意义。高龄组中 Charlson 合并症指数评分<3 分患者的总生存时间和疾病特异生存时间与非高龄组患者差异均无统计学意义。
对于 Charlson 合并症指数评分<3 的高龄局部进展期胃癌患者，行腹腔镜 D1+淋巴结清扫术治疗是安全、有效的。
