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Benefits of laparoscopic surgery compared to open standard surgery for gastric carcinoma in elderly patients: propensity score-matching analysis

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Abstract

Background

Laparoscopic surgery is frequently performed, and laparoscopic gastrectomy (LG) is also widely performed for gastric cancer. Elderly population with gastric cancer has increased in East Asia, including in Japan.

Methods

We examined 1131 patients with gastric cancer who underwent laparoscopic and open standard surgeries (OG). A total of 921 patients of age < 75 years (non-E group) and 210 patients of age ≥ 75 years (E group) underwent surgery for gastric cancer. The mortality, morbidity, and prognosis of LG and OG were compared by propensity score-matched analysis.

Results

Mortality and morbidity in the E group were significantly higher than those in the non-E group (p < 0.05). Propensity score-matching revealed that the incidence of postoperative complications of grade ≥ 2 in the OG subgroup was significantly higher than that in the LG subgroup in the E group (p < 0.05). The overall survival rate of the LG subgroup was significantly higher than that of the OG subgroup in both the non-E and E groups (p < 0.05). The depth of tumor invasion, lymph node metastasis, and the number of dissected lymph nodes were dependent factors for survival in the non-E group, whereas the depth of tumor invasion was the only dependent factor for survival in the E group in the multivariate analysis.

Conclusion

The survival rate of patients who underwent LG showed significantly good prognosis in both the non-E and E groups, although the E group patients who underwent OG subgroup showed higher severe complication incidences than those who underwent LG subgroup.

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Acknowledgements

This work was supported, in part, by a Grant-in Aid from the Ministry of Education, Culture, Sport, Science and Technology of Japan (Grant No. 16K10525), and the Uehara Memorial Foundation.

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Authors and Affiliations

  1. Department of Surgery, Fukuoka Sanno Hospital, 3-6-45 Momochi-hama, Sawara-ku, Fukuoka, 814-0001, Japan

    Manabu Yamamoto

  2. Department of Gastroenterological Surgery, National Kyushu Cancer Center, 3-1-1 Notame, Minami-ku, Fukuoka, 811-1395, Japan

    Manabu Yamamoto, Hiroyuki Kawano, Mitsuhiko Ohta, Daisuke Yoshida, Kazuhito Minami, Masahiko Ikebe, Masaru Morita & Yasushi Toh

  3. Department of Clinical Research Institute, National Kyushu Cancer Center, 3-1-1 Notame, Minami-ku, Fukuoka, 811-1395, Japan

    Mototsugu Shimokawa

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  1. Manabu Yamamoto
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Correspondence to Manabu Yamamoto.

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Manabu Yamamoto, Mototsugu Shimokawa, Hiroyuki Kawano, Mitsuhiko Ohta, Daisuke Yoshida, Kazuhito Minami, Masahiko Ikebe, Masaru Morita, and Yasushi Toh have no conflict of interest to disclose.

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Yamamoto, M., Shimokawa, M., Kawano, H. et al. Benefits of laparoscopic surgery compared to open standard surgery for gastric carcinoma in elderly patients: propensity score-matching analysis. Surg Endosc 33, 510–519 (2019). https://doi.org/10.1007/s00464-018-6325-7

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  • DOI: https://doi.org/10.1007/s00464-018-6325-7

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