Puccetti Francesco, Cinelli Lorenzo, Turi Stefano, Socci Davide, Rosati Riccardo, Elmore Ugo
Department of Gastrointestinal Surgery, IRCCS San Raffaele Scientific Institute, 20132 Milan, Italy.
School of Medicine, Vita-Salute San Raffaele University, 20132 Milan, Italy.
Cancers (Basel). 2024 Jul 7;16(13):2477. doi: 10.3390/cancers16132477.
Minimally invasive surgery has provided several clinical advantages in locally advanced gastric cancer (LAGC) care, although a consensus on its application criteria remains unclear. Surgery remains a careful choice in elderly patients, who frequently present with frailty, comorbidities, and other disabling diseases. This study aims to assess the possible advantages of laparoscopic gastric resections in elderly patients presenting with LAGC. This retrospective study analyzed a single-center series of elderly patients (≥75 years) undergoing curative resections for LAGC between 2015 and 2020. A comparative analysis of open versus laparoscopic approaches was conducted, focusing on postoperative complications, length of hospital stay (LOS), and long-term survival. A total of 62 patients underwent gastrectomy through an open or a laparoscopic approach (31 pts each). The study population did not show statistically significant differences in demographics, operative risk, and neoadjuvant chemotherapy. The laparoscopic group reported significantly minimized overall complications (45.2 vs. 71%, = 0.039) and pulmonary complications (0 vs. 9.7%, = 0.038) as well as a shorter LOS (8 vs. 12 days, = 0.007). Lymph node harvest was equal between the groups, although long-term overall survival presented significantly better after laparoscopic gastrectomy ( = 0.048), without a relevant difference in terms of disease-free and disease-specific survivals. Laparoscopic gastrectomy proves effective in elderly LAGC patients, offering substantial short- and long-term postoperative benefits.
尽管对于其应用标准仍未达成共识，但微创手术在局部晚期胃癌（LAGC）治疗中已展现出多项临床优势。对于常伴有身体虚弱、合并症及其他致残性疾病的老年患者而言，手术仍是一项需谨慎做出的选择。本研究旨在评估腹腔镜胃切除术对于患有LAGC的老年患者可能具有的优势。这项回顾性研究分析了2015年至2020年间在单中心接受LAGC根治性切除术的老年患者（≥75岁）系列病例。对开放手术与腹腔镜手术方法进行了对比分析，重点关注术后并发症、住院时间（LOS）和长期生存率。共有62例患者通过开放或腹腔镜手术方法接受了胃切除术（各31例）。研究人群在人口统计学、手术风险和新辅助化疗方面未显示出统计学上的显著差异。腹腔镜组报告总体并发症（45.2%对71%，P = 0.039）和肺部并发症（0对9.7%，P = 0.038）显著减少，住院时间也更短（8天对12天，P = 0.007）。两组之间的淋巴结清扫数量相当，尽管腹腔镜胃切除术后长期总生存率显著更高（P = 0.048），无病生存率和疾病特异性生存率方面无显著差异。腹腔镜胃切除术在老年LAGC患者中被证明是有效的，在术后短期和长期均带来显著益处。
