Surgical risk and benefits of laparoscopic surgery for elderly patients with gastric cancer: a multicenter prospective cohort study
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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.
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).
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.
The safety of LG in elderly patients was demonstrated. LG shortened the length of postoperative hospital stay.
KeywordsElderly patients Laparoscopic surgery Gastric cancer Complications
Compliance with ethical standards
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.
- 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.
- 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
- 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
- 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
- 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.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.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
- 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