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Minimally invasive surgery as a treatment option for gastric cancer in the elderly: comparison with open surgery for patients 80 years and older

Surgical Endoscopy volume 29, pages 2321–2330 (2015)Cite this article

Abstract

Background

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.

Methods

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.

Results

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.

Conclusions

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.

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Acknowledgments

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).

Disclosures

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.

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Affiliations

  1. Department of Surgery, Yonsei University College of Medicine, 50-1 Yonsei-ro, Seodaemun-gu, Seoul, 120-752, Korea

    In Gyu Kwon, In Cho, Ali Guner, Hyoung-il Kim, Sung Hoon Noh & Woo Jin Hyung

  2. Department of Surgery, Keimyung University School of Medicine, Daegu, Korea

    In Gyu Kwon

  3. Department of Surgery, Trabzon Kanuni Training and Research Hospital, Trabzon, Turkey

    Ali Guner

  4. Robot and MIS Center, Severance Hospital, Yonsei University Health System, Seoul, Korea

    Hyoung-il Kim, Sung Hoon Noh & Woo Jin Hyung

  5. Gastric Cancer Center, Yonsei Cancer Hospital, Yonsei University Health System, Seoul, Korea

    Hyoung-il Kim, Sung Hoon Noh & Woo Jin Hyung

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  1. In Gyu Kwon
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  2. In Cho
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  3. Ali Guner
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Correspondence to Woo Jin Hyung.

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Kwon, I.G., Cho, I., Guner, A. et al. Minimally invasive surgery as a treatment option for gastric cancer in the elderly: comparison with open surgery for patients 80 years and older. Surg Endosc 29, 2321–2330 (2015). https://doi.org/10.1007/s00464-014-3955-2

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  • DOI: https://doi.org/10.1007/s00464-014-3955-2

Keywords

  • Minimally invasive surgery
  • Gastric cancer
  • Elderly
  • Gastrectomy
  • Laparoscopy
  • Octogenarian