Northern Jiangsu People's Hospital, Clinical Teaching Hospital of Medical School, Nanjing University, Yangzhou, China.
Department of General Surgery, Northern Jiangsu People's Hospital, Yangzhou, China.
Surg Endosc. 2024 May;38(5):2756-2769. doi: 10.1007/s00464-024-10798-8. Epub 2024 Apr 4.
The appropriateness of laparoscopic gastrectomy (LG) for super-geriatric patients with locally advanced gastric cancer (LAGC) is inconclusive, and the prognostic factors are also yet to be elucidated. Herein, we aimed to investigate the surgical and oncological outcomes of LG versus open gastrectomy (OG) for geriatric patients with LAGC who have outlived the average lifespan of the Chinese population (≥ 78 years).
This is a monocentric, retrospective, comparative study. A 1:1 propensity score matching (PSM) was performed to minimize selection bias and ensure well-balanced characteristics. The primary endpoint of interest was 3-year overall survival, while secondary endpoints included procedure-related variables, postoperative recovery indices, and complications. Univariate and multivariate Cox proportional hazards regression analyses were performed to identify unfavorable prognostic factors.
Of 196 eligible individuals, 107 underwent LG and 89 underwent OG, with a median age (interquartile range [IQR]) of 82 [79, 84] years. PSM yielded 61 matched pairs, with comparable demographic and tumor characteristics. The LG group had a significantly lower overall complication rate than the OG group (31.1% vs. 49.2%, P = 0.042), as well as shorter duration of postoperative hospital stay [12 (11, 13) vs. 13 (12, 15.5) d, P < 0. 001], less intraoperative blood loss [95 (75, 150) vs. 230 (195, 290) mL, P < 0.001], but a longer operative time [228 (210, 255.5) vs. 196 (180, 219.5) min, P < 0.001]. The times to first aerofluxus, defecation, liquid diet, and half-liquid diet were comparable. Kaplan-Meier analyses revealed no significant difference in 3-year overall survival between the groups, either in the entire cohort or in subgroups with different TNM staging. Moreover, Age-adjusted Charlson Comorbidity Index scores of > 6 [hazard ratio (HR) 4.003; P = 0.021] and pathologic TNM stage III (HR 3.816, P = 0.023) were independent unfavorable prognostic factors for long-term survival.
LG performed by experienced surgeons offers the benefits of comparable or better surgical and oncological safety profiles than OG for super-geriatric patients with LAGC.
腹腔镜胃切除术（LG）是否适用于局部晚期胃癌（LAGC）的超高龄患者尚存争议，且其预后因素也尚未阐明。本研究旨在探讨 LG 与开腹胃切除术（OG）治疗预期寿命超过中国人口平均寿命（≥78 岁）的超高龄 LAGC 患者的手术和肿瘤学结局。
这是一项单中心回顾性对照研究。采用 1:1 倾向评分匹配（PSM）以最小化选择偏倚并确保特征均衡。主要研究终点为 3 年总生存率，次要终点包括手术相关变量、术后恢复指标和并发症。采用单因素和多因素 Cox 比例风险回归分析确定不利的预后因素。
196 例患者中，107 例行 LG，89 例行 OG，中位年龄（四分位距[IQR]）为 82[79,84]岁。PSM 后得到 61 对匹配的患者，其人口统计学和肿瘤特征相似。LG 组的总并发症发生率明显低于 OG 组（31.1% vs. 49.2%，P=0.042），术后住院时间更短[12（11，13） vs. 13（12，15.5）d，P<0.001]，术中出血量更少[95（75，150） vs. 230（195，290）mL，P<0.001]，但手术时间更长[228（210，255.5） vs. 196（180，219.5）min，P<0.001]。首次排气、排便、流质饮食和半流质饮食的时间无差异。Kaplan-Meier 分析显示，两组在整个队列或不同 TNM 分期亚组中，3 年总生存率均无显著差异。此外，年龄调整 Charlson 合并症指数评分>6（风险比[HR]4.003；P=0.021）和病理 TNM 分期 III（HR 3.816，P=0.023）是长期生存的独立不利预后因素。
由经验丰富的外科医生施行 LG 为超高龄 LAGC 患者带来了与 OG 相当或更好的手术和肿瘤学安全性。
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