Skip to main content

Advertisement

SpringerLink
Log in

The safety and feasibility of laparoscopic gastrectomy for gastric cancer in very elderly patients: short-and long-term outcomes

  • Original Article
  • Published:
Surgery Today Aims and scope Submit manuscript

Abstract

Purpose

It remains unclear whether laparoscopic gastrectomy (LG) for gastric cancer is a suitable treatment for very elderly (VE) patients. We aimed to assess the safety and feasibility of LG for gastric cancer in VE patients.

Methods

We reviewed 226 consecutive patients who underwent LG between January 2010 and December 2016. We compared VE patients (age ≥ 80, n = 38) with non-elderly patients (age ≤ 79, n = 188).

Results

An ASA-PS score ≥ 2 was more common in VE group (86.8 vs. 48.9%; P < 0.01). There were no significant differences in the operating time, blood loss, postoperative hospital stay, or postoperative morbidity between the groups. The 3-year survival rate and 3-year disease-specific survival rate were lower in the VE group (53.7 vs. 85.6%; P < 0.0001, 78.5 vs. 92.4%; P = 0.0116). A univariate analysis showed that PS scores ≥ 2, Charlson comorbidity index ≥ 4, and pN stage were independent predictors of decreased overall survival rates in the VE group. A multivariate analysis showed total gastrectomy, a Charlson comorbidity index ≥ 4, and the pN stage to be independent predictors in the VE group.

Conclusion

LG for gastric cancer is, thus, considered to be safe for patients aged 80 years or older. Total gastrectomy, a Charlson comorbidity index ≥ 4, and the pN stage were independent risk factors for a poor prognosis in these patients.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2

Similar content being viewed by others

References

  1. Health_Labor_and_Welfare”M.Vital Statistics in Japan–The latest trend(Japanese). 2018.https://ganjoho.jp/reg_stat/statistics/dl/index.html. Accessed 12 Dec 2018.

  2. Kitano S, Iso Y, Moriyama M, Sugimachi K. Laproscopy-assisted Billroth I gastrectomy. Surg Laparosc Endosc. 1994;4:146–8.

    CAS  PubMed  Google Scholar 

  3. Kim HH, Hyung WJ, Cho GS, Kim MC, Han SU, Kim W, et al. Morbidity and mortality of laparoscopic gastrectomy versus open gastrectomy for gastric cancer: an interim report-a phase III multicenter, prospective, randomized Trial(KLASS Trial). Ann Surg. 2010;251:417–20.

    Article  Google Scholar 

  4. Vinuela EF, Gonen M, Brennan MF, Coit DG, Strong VE. Laparscopic versus open gastrectomy for gastric cancer, a meta-analysis of randomized controlled trials and high-quality nonrandomized studies. Ann Surg. 2012;255:446–56.

    Article  Google Scholar 

  5. Haverkamp L, Brenkman HJ, Seesing MF, Gisbertz SS, van Berge Henegouwen MI, Luyer MD, LOGICA study group. Laparoscopic versus open gastrectomy for gastric cancer, multicenter prospectively randomized controlled trial (LOGICA-trial). BMC Cancer. 2015. https://doi.org/10.1186/S12885-015-1551-Z:556.

    Article  PubMed  PubMed Central  Google Scholar 

  6. Hu Y, Huang C, Sun Y, Su X, Cao H, Hu J, et al. Morbidity and mortality of laparoscopic versus open D2 distal gastrectomy for advanced gastric cancer: a randomized controlled trial. J Clin Oncol. 2016;34:1350–7.

    Article  Google Scholar 

  7. Mohri Y, Yasuda H, Ohi M, Tanaka K, Saigusa S, Okigami M, et al. Short-and long-term outcomes of laparoscopic gastrectomy in elderly patients with gastric cancer. Surg Endosc. 2015;29:1627–35.

    Article  Google Scholar 

  8. Shimoda S, Sawada N, Oae S, Seki J, Takano Y, Ishiyama Y, et al. Safety and curability of laparoscopic gastrectomy in elderly patients with gastric cancer. Surg Endosc. 2018;32:4277–83.

    Article  Google Scholar 

  9. Aratani K, Sakuramoto S, Chuman M, Kasuya M, Wakata M, Miyawaki Y, et al. Laparoscopy-assisted distal gastrectomy for gastric cancer in elderly patients: surgical outcomes and prognosis. Antica Res. 2018;38:1721–5.

    Google Scholar 

  10. Yang XY, Zhu SH, Li PZ, Li WZ, Sun XL. Outcomes of laparoscopic gastrectomy for gastric cancer in elderly patients. JBUON. 2018;23:85–91.

    PubMed  Google Scholar 

  11. Japanese Gastric Cancer Association. Japanese classification of gastric carcinoma. Gastric Cancer. 2011;14:101–12 (3rd English edition).

    Article  Google Scholar 

  12. Dindo D, Demartines N, Clavien P. Classification of surgical complications. A new proposal with evaluation in a cohort of 6336 patients and results of survey. Ann Surg. 2004;240:205–13.

    Article  Google Scholar 

  13. Kitano S, Shiraishi N, Fujiki K, Yasuda K, Inomata M, Adachi Y. A randomized controlled trial comparing open versus laparoscopy-assisted distal gastrectomy for the treatment of early gastric cancer:an interim report. Surgery. 2002;131(1 Suppl):306–11.

    Article  Google Scholar 

  14. Mochiki E, Nakabayashi T, Kamimura H, Haga N, Asao T, Kuwano H. Gastrointestinal recovery and outcome after laparoscopy-assisted versus conventional open distal gastrectomy for early gastric cancer. World J Surg. 2002;26:1145–9.

    Article  Google Scholar 

  15. Huscher CG, Mingoli A, Sgarzini G, Sansonetti A, Di Paola M, Recher A, et al. Laparoscopic versus open subtotal gastrectomy for distal gastric cancer: five-year results of a randomized prospective trial. Ann Surg. 2005;241:232–7.

    Article  Google Scholar 

  16. Kitano S, Shiraishi N, Uyama I, Sugihara K, Tanigawa N, Japanese Laparoscopic Surgery Study Group. A multicenter study on oncologic outcome of laparoscopic gastrectomy for early cancer in Japan. Ann Surg. 2007;245:68–72.

    Article  Google Scholar 

  17. Kim MC, Jung GJ, Kim HH. Morbidity and mortality of laparoscopy-assisted gastrectomy with extraperigastric lymph node dissection for gastric cancer. Dig Dis Sci. 2007;52:543–8.

    Article  Google Scholar 

  18. Kim MC, Kim W, Kim HH, Ryu SW, Ryu SW, Song KY, Korean Laparoscopic Gastrointestinal Surgery Study (KLASS) Group. Risk factors associated with complication following laparoscopy-assisted gastrectomy for gastric cancer: a large-scale korean multicenter study. Ann Surg Oncol. 2008;15:2692–700.

    Article  Google Scholar 

  19. Lee JH, Yom CK, Han HS. Comparison of long-term outcomes of laparoscopy-assisted and open distal gastrectomy for early gastric cancer. Surg Endosc. 2009;23:1759–63.

    Article  Google Scholar 

  20. Katai H, Mizusawa J, Katayama H, Takagi M, Yoshikawa T, Fukagawa T, et al. Short-term surgical outcomes from a phase III study of laparoscopy-assisted versus open distal gastrectomy with nodal dissection for clinical stage IA/IB gastric cancer: Japan Clinical Oncology Group Study JCOG0912. Gastric Cancer. 2017;20:699–708.

    Article  Google Scholar 

  21. Hiki N, Katai H, Mizusawa J, Nakamura K, Nakamori M, Yoshikawa T, Stomach Cancer Study Group of Japan Clinical Oncology Group. Long-term outcomes of laparoscopic -assisted distal gastrectomy with suprapancreatic nodal dissection for clinical stage I gastric cancer: multicenter phase II trial (JCOG0703). Gastric Cancer. 2018;21:155–61.

    Article  Google Scholar 

  22. Li Z, Li B, Bai B, Yu P, Lian B, Zhao Q. Long-term outcomes of laparoscopic versus open D2 gastrectomy for advanced gastric cancer. Surg Oncol. 2018;27:441–8.

    Article  Google Scholar 

  23. Inaki N, Etoh T, Ohyama T, Uchiyama K, Katada N, Koeda K, et al. A multi-institutional, prospective phase II feasibility study of laparoscopy-assisted distal gastrectomy with D2 lymph node dissection for locally advanced gastric cancer(JLSSG0901). World J Surg. 2015;39:2734–41.

    Article  Google Scholar 

  24. Evers EM, Townsend CM Jr, Thompson JC. Organ physiology of aging. Surg Clin North Am. 1994;74:23–39.

    Article  CAS  Google Scholar 

  25. Jeon SH, Ahn HS, Yoo MW, Cho JJ, Lee HJ, Kim HH, et al. Increased morbidity rates in patients with heart disease or chronic liver disease following radical gastric surgery. Ann Surg Oncol. 2010;101:200–4.

    Article  Google Scholar 

  26. Tsuchiya N, Kunisaki C, Makino H, Kimura J, Takagawa R, Sato S, et al. Feasibility of laparoscopy-assisited gastrectomy for gastric cancer in elderly patients: a case-control study. Surg Laparosc Endosc Percutan Tech. 2018;28:102–7.

    PubMed  Google Scholar 

  27. Yoshida M, Koga S, Ishimaru K, Yamamoto Y, Matsuo Y, Akita S, et al. Laparoscopy-assisted distal gastrectomy is feasible also for elderly patients aged 80 years and over: effectiveness and long-term prognosis. Surg Endosc. 2017;31:4431–7.

    Article  Google Scholar 

  28. Inokuchi M, Tanioka T, Nagakawa M, Okuno K, Gokita K, Kojima K. Laparoscopic distal gastrectomy is feasible in very elderly patients as compared with open distal gastrectomy. J Invest Surg. 2017;22:1–7.

    Google Scholar 

  29. Kim SM, Youn HG, An JY, Choi YY, Noh SH, Oh SJ, et al. Comparison of open and laparoscopic gastrectomy in elderly patients. J Gastrointest Surg. 2018;22:785–91.

    Article  Google Scholar 

  30. Matsushita I, Hanai H, Kajimura M, Tamakoshi K, Nakajima T, Matsubayashi Y, et al. Should gastric cancer patients more than 80 years of age undergo surgery? Comparison with patients not treated surgically concerning prognosis and quality of life. J Clin Gastroenterol. 2002;35:29–34.

    Article  Google Scholar 

  31. Choo JW, Ju Y, Lim H, Youn SH, Soh JS, Park JW, et al. Is it beneficial to perform surgical resection in elderly patients more than 80 years old with advanced gastric cancer. Scand J Gastroenterol. 2017;52:1057–64.

    Article  Google Scholar 

  32. Okabe H, Obama K, Tsunoda S, Tanaka E, Sakai Y. Advantage of completely laparoscopic gastrectomy with linear stapled reconstruction. A long-term follow-up study. Ann Surg. 2014;259:109–16.

    Article  Google Scholar 

  33. Zhuang CL, Huang DD, Pang WY, Zhou CJ, Wang SL, Lou N, et al. Sarcopenia is an independent predictor of severe postoperative complications and long-term survival after radical gastrectomy for gastric cancer: analysis from a large-scale cohort. Medicine. 2016;95:e3164.

    Article  Google Scholar 

  34. Nishigori T, Tsunoda S, Obama K, Hisamori K, Hashimoto K, Itatani Y, et al. Optimal cutoff values of skeletal muscle index to define sarcopenia for prediction of survival in patients with advanced gastric cancer. Ann Surg Oncol. 2018;25:3596–603.

    Article  Google Scholar 

  35. Liu P, Hao Q, Hai S, Wang H, Cao Li, Dong B. Sarcopenia as a predictor of all-cause mortality among community-dwelling older people: a systematic review and meta-analysis. Maturitas. 2017;103:16–22.

    Article  Google Scholar 

  36. Beaudart C, Zaaria M, Pasleau F, Reginster JY, Bruyere O. Health outcomes of sarcopenia: a systematic review and meta-analysis. PLoS ONE. 2017;12:e0169548.

    Article  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Surgery, Kobe City Medical Center West Hospital, 2-4, Ichibancho, Nagata-ku, kobe, 653-0013, Japan

    Ryuichi Mikami, Teppei Murakami, Satoshi Ishida, Yugo Matsui, Kenta Horita, Masaki Yamada, Takashi Nitta, Masahiro Mise, Takehisa Harada, Masahiko Takeo & Shigeki Arii

  2. Department of Surgery, Kitano Hospital, Tazuke Kofukai Medical Research Institute, 2-4-20, Ohgi-machi, Kita-ku, Osaka, 530-8480, Japan

    Eiji Tanaka

Authors
  1. Ryuichi Mikami
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Eiji Tanaka
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Teppei Murakami
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Satoshi Ishida
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Yugo Matsui
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Kenta Horita
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Masaki Yamada
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Takashi Nitta
    View author publications

    You can also search for this author in PubMed Google Scholar

  9. Masahiro Mise
    View author publications

    You can also search for this author in PubMed Google Scholar

  10. Takehisa Harada
    View author publications

    You can also search for this author in PubMed Google Scholar

  11. Masahiko Takeo
    View author publications

    You can also search for this author in PubMed Google Scholar

  12. Shigeki Arii
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Ryuichi Mikami.

Ethics declarations

Conflict of interest

The authors declare no conflicts of interest in association with this study.

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Electronic supplementary material

Below is the link to the electronic supplementary material.

Supplementary file 1 (PPTX 52 kb)

Supplementary file 2 (PPTX 52 kb)

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Mikami, R., Tanaka, E., Murakami, T. et al. The safety and feasibility of laparoscopic gastrectomy for gastric cancer in very elderly patients: short-and long-term outcomes. Surg Today 51, 219–225 (2021). https://doi.org/10.1007/s00595-020-02078-4

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00595-020-02078-4

Keywords

Search

Navigation