Minimally invasive surgery as a treatment option for gastric cancer in the elderly: comparison with open surgery for patients 80 years and older
As life expectancy is increasing, the use of minimally invasive surgery (MIS) in the elderly is gaining interest. The aim of this study was to identify the impact of minimally invasive gastrectomy by comparing the procedure to open surgery in octogenarians. In addition, we also evaluated the role of gastrectomy in elderly gastric cancer patients by assessing long-term outcomes.
We retrospectively analyzed data from 99 gastric cancer patients aged 80 years or older, who underwent gastrectomy by either MIS or open surgery from 2005 to 2010. Patient characteristics, operative outcomes, pathologic results, morbidity, mortality, and follow-up data (including survival) were compared.
Thirty patients underwent gastrectomy with MIS (19 laparoscopic and 11 robotic) and 69 patients underwent open gastrectomy. MIS demonstrated significantly less blood loss, lower analgesic consumption, faster time to first flatus and soft diet, and a shorter post-operative hospital stay. Multivariate analysis revealed that the type of operation had no effect on the occurrence of complications. There were two postoperative mortalities, both in the open group. Excluding these patients, the overall and disease-specific 5-year survival rates were 57.4 and 70.0 %, respectively. The overall (MIS 70.0 %; open 52.0 %) and disease-specific (MIS 81.8 %; open 65.1 %) 5-year survival rates were similar for the two groups. When we analyzed the 85 patients underwent curative resection only, the overall (MIS 71.4 %; open 58.4 %) and disease-specific (MIS 84.1 %; open 73.6 %) 5-year survival rates were similar for the two groups.
MIS for gastric cancer may be performed safely and maintains the advantages of minimal invasiveness, even in extremely old patients. Furthermore, gastrectomy by either by MIS or open surgery can reduce gastric cancer-related deaths, even in patients 80 years or older.
KeywordsMinimally invasive surgery Gastric cancer Elderly Gastrectomy Laparoscopy Octogenarian
We acknowledge the assistance of BioScience Writers, LLC (Houston, TX, USA) in copyediting of the manuscript and correcting the English language usage. This work was supported by a grant from the Korea Healthcare technology R&D project, Ministry of Health, Welfare, & Family Affairs, Republic of Korea (1320270).
All authors (I.G. Kwon, I. Cho, A. Guner, H. Kim, S.H. Noh, and W.J. Hyung) have no conflicts of interest or financial ties to disclose.
- 1.Office for National Statistics (2012) Period and cohort life expectancy tables, 2010-based. http://www.ons.gov.uk/ons. Accessed Jan 10 2014
- 2.World Health Organization (WHO) Life expectancy: Life table by country. http://apps.who.int/gho/data/node.main.692?lang=en. Accessed Jan 10 2014
- 14.Neudecker J, Sauerland S, Neugebauer E, Bergamaschi R, Bonjer HJ, Cuschieri A, Fuchs KH, Jacobi C, Jansen FW, Koivusalo AM, Lacy A, McMahon MJ, Millat B, Schwenk W (2002) The European Association for Endoscopic Surgery clinical practice guideline on the pneumoperitoneum for laparoscopic surgery. Surg Endosc 16(7):1121–1143PubMedCrossRefGoogle Scholar
- 18.AJCC cancer staging manual (2010) 11. Stomach, 7th edn. Springer, New YorkGoogle Scholar
- 24.Park J, Kim D, Kim J, Kim Y, Nam J (2012) Laparoscopic versus open radical hysterectomy for elderly patients with early-stage cervical cancer. Am J Obstet Gynecol 207(3):195.e1–8Google Scholar
- 27.Paoletti X, Oba K, Burzykowski T, Michiels S, Ohashi Y, Pignon J, Rougier P, Sakamoto J, Sargent D, Sasako M, Van Cutsem E, Buyse M (2010) Benefit of adjuvant chemotherapy for resectable gastric cancer: a meta-analysis. JAMA (Chicago, Ill) 303(17):1729–1737Google Scholar
- 28.Sakuramoto S, Sasako M, Yamaguchi T, Kinoshita T, Fujii M, Nashimoto A, Furukawa H, Nakajima T, Ohashi Y, Imamura H, Higashino M, Yamamura Y, Kurita A, Arai K (2007) Adjuvant chemotherapy for gastric cancer with S-1, an oral fluoropyrimidine. N Engl J Med 357(18):1810–1820PubMedCrossRefGoogle Scholar
- 30.Kim H, Hyung WJ, Cho GS, Kim MC, Han S, Kim W, Ryu S, Lee H, Song KY (2010) 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 251(3):417–420PubMedCrossRefGoogle Scholar