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Journal of Gastrointestinal Surgery

, Volume 19, Issue 11, pp 1949–1957 | Cite as

Short- and Long-Term Outcomes After Laparoscopic Versus Open Total Gastrectomy for Elderly Gastric Cancer Patients: a Propensity Score-Matched Analysis

  • Jun Lu
  • Chang-ming Huang
  • Chao-hui Zheng
  • Ping Li
  • Jian-wei Xie
  • Jia-bin Wang
  • Jian-xian Lin
  • Qi-yue Chen
  • Long-long Cao
  • Mi Lin
Original Article

Abstract

Background

To date, it has been unclear whether laparoscopic-assisted total gastrectomy (LTG) was a suitable treatment for elderly patients (aged 65 years and older) with gastric cancer. The aim of the present study was to clarify the value of LTG in the elderly using a propensity score matching method.

Methods

We prospectively collected data from 675 elderly gastric cancer patients who underwent total gastrectomies at our institution between January 2002 and February 2012. Propensity score matching was applied at a ratio of 1:1 to compare the LTG and open total gastrectomy (OTG) groups. The operation results, hospital courses, and survival rates were compared between the matched groups.

Results

The LTG group had a significantly shorter mean operating time (194 vs. 267 min, P < 0.001) and significantly less intraoperative blood loss (92 vs. 204 ml, P < 0.001). The total number of collected lymph nodes was similar in the two groups. Postoperatively, the length of hospital stay was shorter in the LTG group than in the OTG group (median 14.4 vs. 16.6 days; P = 0.001); however, no significant intergroup differences were found in morbidity or mortality. Furthermore, the 3-year overall survival (OS) rate was similar between the two groups (P = 0.517).

Conclusions

LTG for elderly gastric cancer is feasible and safe with acceptable oncologic outcomes. Therefore, patient age alone should not be considered a contraindication in the decision between LTG and OTG treatment options. A high-volume prospective study is needed to confirm this rationale.

Keywords

Gastric cancer Elderly patients Laparoscopic total gastrectomy Propensity-matched study Survival 

Notes

Acknowledgments

The authors thank the medical staff who contributed to the success of this patient management.

Conflict of Interest

The authors declare that they have no competing interests.

Financial Support

This work was supported by the National Key Clinical Specialty Discipline Construction Program of China (No. [2012]649) and Key Projects of Science and Technology Plan of Fujian Province (No. 2014Y0025).

References

  1. 1.
    Atsushi Nashimoto. Current status of treatment strategy for elderly patients with gastric cancer. Int J Clin Oncol. 2013;18(6):969–70.CrossRefPubMedGoogle Scholar
  2. 2.
    Korc-Grodzicki B, Downey RJ, Shahrokni A, et al. Surgical considerations in older adults with cancer. J Clin Oncol. 2014;32(24):2647–53.CrossRefPubMedGoogle Scholar
  3. 3.
    Pal SK, Katheria V, Hurria A. Evaluating the older patient with cancer: Understanding frailty and the geriatric assessment. CA Cancer J Clin. 2010;60(2):120–32.CrossRefPubMedGoogle Scholar
  4. 4.
    Eguchi T, Fujii M, Takayama T. Mortality for gastric cancer in elderly patients. J Surg Oncol 2003; 84(3):132–6.CrossRefPubMedGoogle Scholar
  5. 5.
    Jeong O, Park YK, Ryu SY, et al. Effect of age on surgical outcomes of extended gastrectomy with D2 lymph node dissection in gastric carcinoma: prospective cohort study. Ann Surg Oncol 2010;17(6):1589–96.CrossRefPubMedGoogle Scholar
  6. 6.
    Park DJ, Lee HJ, Kim HH, et al. Predictors of operative morbidity and mortality in gastric cancer surgery. Br J Surg. 2005;92(9):1099–102.CrossRefPubMedGoogle Scholar
  7. 7.
    Katai H, Sasako M, Sano T, et al. Gastric cancer surgery in the elderly without operative mortality. Surg Oncol. 2004; 13(4):235–8.CrossRefPubMedGoogle Scholar
  8. 8.
    Hayashi T, Yoshikawa T, Aoyama T, et al. Severity of complications after gastrectomy in elderly patients with gastric cancer. World J Surg. 2012;36(9):2139–45.CrossRefPubMedGoogle Scholar
  9. 9.
    Kitano S, Iso Y, Moriyama M, Sugimachi K. Laparoscopy-assisted Billroth I gastrectomy. Surg Laparosc Endosc. 1994;4(2):146–8.PubMedGoogle Scholar
  10. 10.
    Kim Y, Baik YH, Yun YH, et al. Improved quality of life outcomes after laparoscopy assisted distal gastrectomy for early gastric cancer: results of a prospective randomized clinical trial. Ann Surg. 2008;248(5):721–7.CrossRefPubMedGoogle Scholar
  11. 11.
    Kim MC, Kim W, Kim HH, et al. Risk factors associated with complication following laparoscopy-assisted gastrectomy for gastric cancer: a large-scale Korean multicenter study. Ann Surg Oncol. 2008;15(10):2692–700.CrossRefPubMedGoogle Scholar
  12. 12.
    Memon MA, Khan S, Yunus RN, et al. Meta-analysis of laparoscopic and open distal gastrectomy for gastric carcinoma. Surg Endosc. 2008;22(8):1781–9.CrossRefPubMedGoogle Scholar
  13. 13.
    Son T, Lee JH, Kim YM, et al. Robotic spleen- preserving total gastrectomy for gastric cancer: comparison with conventional laparoscopic procedure. Surg Endosc 2014;28:2606–2615.CrossRefPubMedGoogle Scholar
  14. 14.
    Nagai E, Nakata K, Ohuchida K, et al. Laparoscopic total gastrectomy for remnant gastric cancer: feasibility study. Surg Endosc. 2014;28(9):2606–15.CrossRefGoogle Scholar
  15. 15.
    Lee SR, Kim HO, Son BH, et al. Laparoscopic- assisted total gastrectomy versus open total gastrectomy for upper and middle gastric cancer in short-term and long-term outcomes. Surg Laparosc Endosc Percutan Tech. 2014;24(3):277–82.CrossRefPubMedGoogle Scholar
  16. 16.
    Huang CM, Chen QY, Lin JX, et al. Laparoscopic spleen- preserving no. 10 lymph node dissection for advanced proximal gastric cancer using a left approach. Ann Surg Oncol. 2014;21(6):2051.CrossRefPubMedGoogle Scholar
  17. 17.
    Jia-Bin W, Chang-Ming H, Chao-Hui Z, et al. Laparoscopic spleen- preserving no. 10 lymph node dissection for advanced proximal gastric cancer in left approach: a new operation procedure. World J Surg Oncol. 2012; 10:241.PubMedCentralCrossRefPubMedGoogle Scholar
  18. 18.
    Yu J, Hu J, Huang C, et al. The impact of age and comorbidity on postoperative complications in patients with advanced gastric cancer after laparoscopic D2 gastrectomy: Results from the Chinese laparoscopic gastrointestinal surgery study (CLASS) group. Eur J Surg Oncol. 2013;39(10):1144–9.CrossRefPubMedGoogle Scholar
  19. 19.
    Anonymous: Japanese gastric cancer treatment guidelines 2010 (ver. 3). Gastric Cancer. 2011;14(2):113–23.CrossRefGoogle Scholar
  20. 20.
    Sobin LH, Gospodarowicz MK, Wittekind C. International Union Against Cancer (UICC) TNM Classification of Malignant tumours. 7th ed. New York: Wiley-Liss; 2010.Google Scholar
  21. 21.
    Jeong O, Jung MR, Kim GY, et al. Comparison of short-term surgical outcomes between laparoscopic and open total gastrectomy for gastric carcinoma: case–control study using propensity score matching method. J Am Coll Surg. 2013; 216(2):184–91.CrossRefPubMedGoogle Scholar
  22. 22.
    Zhao XF, Jeong O, Jung MR, et al. A propensity score- matched case–control comparative study of laparoscopic and open extended (d2) lymph node dissection for distal gastric carcinoma. Surg Endosc. 2013; 27(8):2792–800.CrossRefPubMedGoogle Scholar
  23. 23.
    Mohri Y, Yasuda H, Ohi M, Tanaka K, et al. Short- and long-term outcomes of laparoscopic gastrectomy in elderly patients with gastric cancer. Surg Endosc. 2015;29(6):1627–35.CrossRefPubMedGoogle Scholar
  24. 24.
    Dindo D, Demartines N, Clavien PA. Classification of surgical complications: a new proposal with evaluation in a cohort of 6336 patients and results of a survey. Ann Surg. 2004;240(2):205–13.PubMedCentralCrossRefPubMedGoogle Scholar
  25. 25.
    Yasunaga H, Horiguchi H, Kuwabara K, et al. Outcomes after laparoscopic or open distal gastrectomy for early-stage gastric cancer: a propensity- matched analysis. Ann Surg. 2013;257(4):640–6.CrossRefPubMedGoogle Scholar
  26. 26.
    Aalami OO, Fang TD, Song HM, et al. Physiological features of aging persons. Arch Surg. 2003; 138(10):1068–76.CrossRefPubMedGoogle Scholar
  27. 27.
    Mochiki E, Ohno T, Kamiyama Y, et al. Laparoscopy-assisted gastrectomy for early gastric cancer in young and elderly patients. World J Surg. 2005; 29(12):1585–91.CrossRefPubMedGoogle Scholar
  28. 28.
    Kim MG, Kim HS, Kim BS,et al. The impact of old age on surgical outcomes of totally laparoscopic gastrectomy for gastric cancer. Surg Endosc 2013; 27(11):3990–7.CrossRefPubMedGoogle Scholar
  29. 29.
    Huscher CG, Mingoli A, Sgarzini G, et al. Laparoscopic versus open subtotal gastrectomy for distal gastric cancer: five-year results of a randomized prospective trial. Ann Surg. 2005;241(2):232–7.PubMedCentralCrossRefPubMedGoogle Scholar
  30. 30.
    Kim MG, Yook JH, Kim KC,et al. Influence of obesity on early surgical outcomes of laparoscopic-assisted gastrectomy in gastric cancer. Surg Laparosc Endosc Percutan Tech. 2011;21(3):151–4.CrossRefPubMedGoogle Scholar
  31. 31.
    Yasuda K, Sonoda K, Shiroshita H, et al. Laparoscopically assisted distal gastrectomy for early gastric cancer in the elderly. Br J Surg. 2004;91(8):1061–5.CrossRefPubMedGoogle Scholar
  32. 32.
    Cho GS, Kim W, Kim HH, et al. Multicentre study of the safety of laparoscopic subtotal gastrectomy for gastric cancer in the elderly. Br J Surg. 2009;96(12):1437–42.CrossRefPubMedGoogle Scholar
  33. 33.
    Shinohara T, Kanaya S. Laparoscopic total gastrectomy with D2 lymph node dissection for gastric cancer. Arch Surg. 2009;144(12):1138–42.CrossRefPubMedGoogle Scholar
  34. 34.
    Lee JH, Ahn SH, Park do J, et al. Laparoscopic total gastrectomy with d2 lymphadenectomy for advanced gastric cancer. World J Surg. 2012;36(10):2394–9.CrossRefPubMedGoogle Scholar
  35. 35.
    D’Agostino RB Jr. Propensity score methods for bias reduction in the comparison of a treatment to a non-randomized control group. Stat Med. 1998;17(19):2265–81.CrossRefPubMedGoogle Scholar
  36. 36.
    Yasuda K, Shiraishi N, Adachi Y, et al. Risk factors for complications following resection of large gastric cancer. Br J Surg. 2001;88(6):873–7.CrossRefPubMedGoogle Scholar
  37. 37.
    Kim MC, Jung GJ, Kim HH. Learning curve of laparoscopy-assisted distal gastrectomy with systemic lymphadenectomy for early gastric cancer.World J Gastroenterol. 2005;11(47):7508–11.CrossRefPubMedGoogle Scholar
  38. 38.
    Fujiwara M, Kodera Y, Miura S, et al. Laparoscopy-assisted distal gastrectomy with systemic lymph node dissection: a phase II study following the learning curve. J Surg Oncol. 2005;91(1):26–32.CrossRefPubMedGoogle Scholar
  39. 39.
    Wang W, Zhang X, Shen C, et al. Laparoscopic versus open total gastrectomy for gastric cancer: An updated meta-Analysis. PLos One. 2014;9(2):e88753.PubMedCentralCrossRefPubMedGoogle Scholar
  40. 40.
    Kunisaki C, Makino H, Takagawa R, et al. Efficacy of laparoscopy-assisted distal gastrectomy for gastric cancer in the elderly. Surg Endosc. 2009;23(2) :377–83.CrossRefPubMedGoogle Scholar
  41. 41.
    Habu H, Endo M. Gastric cancer in elderly patients-Results of surgical treatment. Hepatogastroenterology. 1989;36(2):71–4.PubMedGoogle Scholar
  42. 42.
    Wu WC, Smith TS, Henderson WG, et al. Operative blood loss, blood transfusion, and 30-day mortality in older patients after major noncardiac surgery. Ann Surg. 2010;252(1):11–7.CrossRefPubMedGoogle Scholar
  43. 43.
    Kim HH; Han SU; Kim MC; et al. Long-term results of laparoscopic gastrectomy for gastric cancer: a large-scale case–control and case- matched Korean multicenter study. J Clin Oncol 2014;32(7):627–33.CrossRefPubMedGoogle Scholar
  44. 44.
    Kitano S, Shiraishi N, Uyama I, et al. A multicenter study on oncologic outcome of laparoscopic gastrectomy for early cancer in Japan. Ann Surg. 2007;245(1):68–72.PubMedCentralCrossRefPubMedGoogle Scholar
  45. 45.
    Park DJ, Han SU, Hyung WJ, et al. Long-term outcomes after laparoscopy-assisted gastrectomy for advanced gastric cancer: a large-scale multicenter retrospective study. Surg Endosc. 2012;26(6):1548–53.CrossRefGoogle Scholar

Copyright information

© The Society for Surgery of the Alimentary Tract 2015

Authors and Affiliations

  • Jun Lu
    • 1
  • Chang-ming Huang
    • 1
  • Chao-hui Zheng
    • 1
  • Ping Li
    • 1
  • Jian-wei Xie
    • 1
  • Jia-bin Wang
    • 1
  • Jian-xian Lin
    • 1
  • Qi-yue Chen
    • 1
  • Long-long Cao
    • 1
  • Mi Lin
    • 1
  1. 1.Department of Gastric SurgeryFujian Medical University Union HospitalFuzhouChina

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