Advertisement

Gastric Cancer

, Volume 22, Issue 4, pp 845–852 | Cite as

Surgical risk and benefits of laparoscopic surgery for elderly patients with gastric cancer: a multicenter prospective cohort study

  • Michitaka Honda
  • Hiraku Kumamaru
  • Tsuyoshi Etoh
  • Hiroaki Miyata
  • Yuichi Yamashita
  • Kazuhiro Yoshida
  • Yasuhiro Kodera
  • Yoshihiro Kakeji
  • Masafumi Inomata
  • Hiroyuki Konno
  • Yasuyuki Seto
  • Seigo Kitano
  • Masahiko Watanabe
  • Naoki HikiEmail author
Original Article
  • 502 Downloads

Abstract

Background

Laparoscopic gastrectomy (LG) might have greater clinical benefits for elderly patients as less invasive surgery; however, there is still little evidence to support its benefit. We evaluated the surgical outcomes of elderly patients in a nationwide prospective cohort study.

Methods

One hundred and sixty-nine participating institutions were identified by stratified random sampling, and were adjusted for hospital volume, type and location. During 1 year from 2014 to 2015, consecutive patients who underwent gastrectomy for gastric cancer were prospectively enrolled. ‘Elderly’ was defined as ≥ 75 years of age, based on the prevalence of comorbidities and the activities of daily living of patients of this age. We compared the surgical outcomes of LG to those of open gastrectomy (OG) in non-elderly and elderly patients. The primary outcome was the incidence of severe morbidities (Grade ≥ 3).

Results

Eight thousand nine hundred and twenty-seven patients were enrolled [non-elderly, n = 6090 (OG, n = 2602; LG, n = 3488); elderly, n = 2837 (OG, n = 1471; LG, n = 1366)]. Grade ≥ 3 complications occurred in 161 (10.9%) patients who underwent OG and 98 (7.2%) who underwent LG (p < 0.001). After adjusting for confounding factors, we confirmed that laparoscopic surgery was not an independent risk factor (odds ratio = 0.81, 0.60–1.09). OG was associated with a significantly longer median length of postoperative stay in comparison to LG (16 versus 12 days, p < 0.001). There were no significant differences in the incidence of other postoperative comorbidities.

Conclusion

The safety of LG in elderly patients was demonstrated. LG shortened the length of postoperative hospital stay.

Keywords

Elderly patients Laparoscopic surgery Gastric cancer Complications 

Notes

Compliance with ethical standards

Ethical approval

All study procedures were conducted in accordance with the ethical standards of the respective committees on human experimentation (institutional and national) and with the Helsinki Declaration of 1964 and later versions. The study was approved by the Institutional Review Board of Cancer Institute Hospital, Japanese Foundation for Cancer Research.

Conflict of interest

Dr. Kodera reports grants and personal fees from Taiho Pharmaceutical, grants and personal fees from Chugai Pharmaceutical, grants from Sanofi, grants from Merck Serono, grants and personal fees from Yakult Honsha, grants from Daiichi Sankyo, grants and personal fees from Otsuka Pharmaceutical Factory, grants from Takeda Pharmaceutical, personal fees from Johnson & Johnson, personal fees from Asahi Kasei Pharma, grants and personal fees from Eli Lilly Japan, grants from Pfizer Japan, grants from EA Pharmaceuticals, grants and personal fees from ONO Pharmaceutical, grants and personal fees from Kaken Pharmaceutical, grants from Covidien Japan, grants from Shionogi, grants from Bristol-Myers Squibb, grants from Japan Blood Products Organization, grants from AbbVie GK, grants from Otsuka Pharmaceutical, grants from Eizai, grants from Abbott Japan, grants from CSL Behring, grants from Tsumura, grants from Nippon Kayaku, grants from Novartis Pharmaceuticals Japan, grants from KCI, grants from Maruho, personal fees from MSD, outside the submitted work.

References

  1. 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 10 June 2018.
  2. 2.
    Sandini M, Pinotti E, Persico I, Picone D, Bellelli G, Gianotti L. Systematic review and meta-analysis of frailty as a predictor of morbidity and mortality after major abdominal surgery. BJS Open. 2017;1:128–37.CrossRefPubMedPubMedCentralGoogle Scholar
  3. 3.
    Gupta PK, Gupta H, Sundaram A, Kaushik M, Fang X, Miller WJ, et al. Development and validation of a risk calculator for prediction of cardiac risk after surgery. Circulation. 2011;124:381–7.CrossRefGoogle Scholar
  4. 4.
    Kneuertz PJ, Pitt HA, Bilimoria KY, Smiley JP, Cohen ME, Ko CY, et al. Risk of morbidity and mortality following hepato-pancreato-biliary surgery. J Gastrointest Surg. 2012;16:1727–35.CrossRefGoogle Scholar
  5. 5.
    Soveri I, Holme I, Holdaas H, Budde K, Jardine AG, Fellstrom B. A cardiovascular risk calculator for renal transplant recipients. Transplantation. 2012;94:57–62.CrossRefPubMedGoogle Scholar
  6. 6.
    Abete P, Cherubini A, Di Bari M, Vigorito C, Viviani G, Marchionni N, et al. Does comprehensive geriatric assessment improve the estimate of surgical risk in elderly patients? An Italian multicenter observational study. Am J Surg. 2016;211:76–83e2.CrossRefPubMedGoogle Scholar
  7. 7.
    Stornes T, Wibe A, Endreseth BH. Complications and risk prediction in treatment of elderly patients with rectal cancer. Int J Colorectal Dis. 2016;31:87–93.CrossRefPubMedGoogle Scholar
  8. 8.
    Kenig J, Mastalerz K, Mitus J, Kapelanczyk A. The Surgical Apgar score combined with Comprehensive Geriatric Assessment improves short- but not long-term outcome prediction in older patients undergoing abdominal cancer surgery. J Geriatr Oncol. 2018;9(6):642–8.  https://doi.org/10.1016/j.jgo.2018.05.012.CrossRefPubMedGoogle Scholar
  9. 9.
    Kim SW, Han HS, Jung HW, Kim KI, Hwang DW, Kang SB, et al. Multidimensional frailty score for the prediction of postoperative mortality risk. JAMA Surg. 2014;149:633–40.CrossRefPubMedGoogle Scholar
  10. 10.
    Yamamoto M, Shimokawa M, Kawano H, Ohta M, Yoshida D, Minami K, et al. Benefits of laparoscopic surgery compared to open standard surgery for gastric carcinoma in elderly patients: propensity score-matching analysis. Surg Endosc. 2018.  https://doi.org/10.1007/s00464-018-6325-7.CrossRefPubMedGoogle Scholar
  11. 11.
    Shimada 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(10):4277–83.  https://doi.org/10.1007/s00464-018-6177-1.CrossRefPubMedGoogle Scholar
  12. 12.
    Zong L, Wu A, Wang W, Deng J, Aikou S, Yamashita H, et al. Feasibility of laparoscopic gastrectomy for elderly gastric cancer patients: meta-analysis of non-randomized controlled studies. Oncotarget. 2017;8:51878–87.PubMedPubMedCentralGoogle Scholar
  13. 13.
    Etoh T, Honda M, Kumamaru H, Miyata H, Yoshida K, Kodera Y, et al. Morbidity and mortality from a propensity score-matched, prospective cohort study of laparoscopic versus open total gastrectomy for gastric cancer: data from a nationwide web-based database. Surg Endosc. 2018;32:2766–73.CrossRefPubMedGoogle Scholar
  14. 14.
    Hiki N, Honda M, Etoh T, Yoshida K, Kodera Y, Kakeji Y, et al. Higher incidence of pancreatic fistula in laparoscopic gastrectomy. Real-world evidence from a nationwide prospective cohort study. Gastric Cancer. 2018;21:162–70.CrossRefPubMedGoogle Scholar
  15. 15.
    Kodera Y, Yoshida K, Kumamaru H, Kakeji Y, Hiki N, Etoh T, et al. Introducing laparoscopic total gastrectomy for gastric cancer in general practice: a retrospective cohort study based on a nationwide registry database in Japan. Gastric cancer. 2018.  https://doi.org/10.1007/s10120-018-0795-0.CrossRefPubMedGoogle Scholar
  16. 16.
    Yoshida K, Honda M, Kumamaru H, Kodera Y, Kakeji Y, Hiki N, et al. Surgical outcomes of laparoscopic distal gastrectomy compared to open distal gastrectomy: a retrospective cohort study based on a nationwide registry database in Japan. Ann Gastroenterol Surg. 2018;2:55–64.CrossRefPubMedGoogle Scholar
  17. 17.
    Katai H, Sasako M, Fukuda H, Nakamura K, Hiki N, Saka M, et al. Safety and feasibility of laparoscopy-assisted distal gastrectomy with suprapancreatic nodal dissection for clinical stage I gastric cancer: a multicenter phase II trial (JCOG 0703). Gastric cancer. 2010;13:238–44.CrossRefPubMedGoogle Scholar
  18. 18.
    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.CrossRefGoogle Scholar
  19. 19.
    Haverkamp L, Brenkman HJ, Seesing MF, Gisbertz SS, van Berge Henegouwen MI, Luyer MD, et al. Laparoscopic versus open gastrectomy for gastric cancer, a multicenter prospectively randomized controlled trial (LOGICA-trial). BMC Cancer. 2015;15:556.CrossRefPubMedPubMedCentralGoogle Scholar
  20. 20.
    Sakuramoto S, Yamashita K, Kikuchi S, Futawatari N, Katada N, Watanabe M, et al. Laparoscopy versus open distal gastrectomy by expert surgeons for early gastric cancer in Japanese patients: short-term clinical outcomes of a randomized clinical trial. Surg Endosc. 2013;27:1695–705.CrossRefPubMedGoogle Scholar
  21. 21.
    Lee JH, Kim YW, Ryu KW, Lee JR, Kim CG, Choi IJ, et al. A phase-II clinical trial of laparoscopy-assisted distal gastrectomy with D2 lymph node dissection for gastric cancer patients. Ann Surg Oncol. 2007;14:3148–53.CrossRefPubMedGoogle Scholar
  22. 22.
    Wang JF, Zhang SZ, Zhang NY, Wu ZY, Feng JY, Ying LP, et al. Laparoscopic gastrectomy versus open gastrectomy for elderly patients with gastric cancer: a systematic review and meta-analysis. World J Surg Oncol. 2016;14:90.CrossRefPubMedPubMedCentralGoogle Scholar
  23. 23.
    Pan Y, Chen K, Yu WH, Maher H, Wang SH, Zhao HF, et al. Laparoscopic gastrectomy for elderly patients with gastric cancer: a systematic review with meta-analysis. Medicine. 2018;97:e0007.CrossRefPubMedPubMedCentralGoogle Scholar
  24. 24.
    Shen Y, Hao Q, Zhou J, Dong B. The impact of frailty and sarcopenia on postoperative outcomes in older patients undergoing gastrectomy surgery: a systematic review and meta-analysis. BMC Geriatr. 2017;17:188.CrossRefPubMedPubMedCentralGoogle Scholar
  25. 25.
    Tsujiura M, Hiki N, Ohashi M, Nunobe S, Kumagai K, Ida S, et al. “Pancreas-Compressionless Gastrectomy”: a Novel Laparoscopic Approach for Suprapancreatic Lymph Node Dissection. Ann Surg Oncol. 2017;24:3331–7.CrossRefGoogle Scholar
  26. 26.
    Suzuki S, Kanaji S, Matsuda Y, Yamamoto M, Hasegawa H, Yamashita K, et al. Long-term impact of postoperative pneumonia after curative gastrectomy for elderly gastric cancer patients. Ann Gastroenterol Surg. 2018;2:72–8.CrossRefPubMedGoogle Scholar

Copyright information

© The International Gastric Cancer Association and The Japanese Gastric Cancer Association 2018

Authors and Affiliations

  • Michitaka Honda
    • 1
  • Hiraku Kumamaru
    • 2
  • Tsuyoshi Etoh
    • 3
  • Hiroaki Miyata
    • 4
  • Yuichi Yamashita
    • 5
  • Kazuhiro Yoshida
    • 6
  • Yasuhiro Kodera
    • 7
  • Yoshihiro Kakeji
    • 8
  • Masafumi Inomata
    • 3
  • Hiroyuki Konno
    • 9
  • Yasuyuki Seto
    • 10
  • Seigo Kitano
    • 11
  • Masahiko Watanabe
    • 12
  • Naoki Hiki
    • 13
    Email author
  1. 1.Department Minimally invasive surgical and medical oncologyFukushima Medical UniversityFukushimaJapan
  2. 2.Department of Healthcare Quality Assessment, Graduate School of MedicineUniversity of TokyoTokyoJapan
  3. 3.Department of Gastroenterological and Pediatric Surgery, Faculty of MedicineOita UniversityOitaJapan
  4. 4.Department of Health Policy and Management, School of MedicineKeio UniversityTokyoJapan
  5. 5.Department of Gastroenterological Surgery, Faculty of MedicineFukuoka UniversityFukuokaJapan
  6. 6.Department of Surgical Oncology, Graduate School of MedicineGifu UniversityGifuJapan
  7. 7.Department of Gastroenterological Surgery, Graduate School of MedicineNagoya UniversityNagoyaJapan
  8. 8.Division of Gastrointestinal Surgery, Department of Surgery, Graduate School of MedicineKobe UniversityKobeJapan
  9. 9.Database Committee, the Japanese Society of Gastroenterological SurgeryTokyoJapan
  10. 10.The Japanese Society of Gastroenterological SurgeryTokyoJapan
  11. 11.Oita UniversityOitaJapan
  12. 12.Department of SurgeryKitasato University School of MedicineSagamiharaJapan
  13. 13.Department of Gastroenterological Surgery, Gastroenterological CenterCancer Institute Ariake Hospital of Japanese Foundation for Cancer ResearchTokyoJapan

Personalised recommendations