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Carbon Dioxide Pneumoperitoneum Led to No Severe Morbidities for the Elderly During Laparoscopic-Assisted Distal Gastrectomy

  • Gastrointestinal Oncology
  • Published:
Annals of Surgical Oncology Aims and scope Submit manuscript

Abstract

Background

Our purpose was to evaluate the perioperative safety of laparoscopic-assisted distal gastrectomy (LADG) in elderly patients with clinical stage I gastric cancer.

Methods

From 527 consecutive patients who underwent distal gastrectomy for gastric cancer from 2000 to 2011, 38 elderly patients (aged 75 years or older) with clinical stage I disease who underwent LADG were compared with 28 elderly patients who underwent open distal gastrectomy (ODG) and with 41 nonelderly patients (younger than aged 65 years) who underwent LADG. Intraoperative cardiopulmonary changes following pneumoperitoneum and surgical outcomes were analyzed.

Results

A significant elevation in mean blood pressure (MAP) (by 44 %) and slight increase in heart rate (HR) (by 13 %) were observed 5 min after the beginning of pneumoperitoneum in the elderly LADG group, although they tended to remain stable since 30 min. The elevation of end-tidal CO2 (ETCO2) in the elderly LADG group remained at 8 % and did not differ from that in the nonelderly LADG group who were 20.5 years (median) younger, whereas percutaneous oxygen saturation (SpO2) did not worsen. Compared with the elderly ODG group, the elderly LADG group did not increase intraoperative cardiopulmonary impairment or complication, had lower incidence of postoperative medical complication (7.9 vs. 32.1 %, p = 0.012) and shortened postoperative recovery course (25 vs. 15 days, p < 0.001). Pneumoperitoneum did not necessarily impair cardiopulmonary dynamics or prognosis for elderly patients with declining cardiopulmonary function.

Conclusions

Cardiopulmonary impairment caused by pneumoperitoneum was not critical but transitory. LADG led to superior perioperative course for elderly patients with early gastric cancer.

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Disclosure

The authors declare no conflict of interest.

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Authors and Affiliations

  1. Division of Gastrointestinal Surgery, Department of Surgery, Graduate School of Medicine, Kobe University, Kobe, Hyogo, Japan

    Satoshi Suzuki MD, PhD, Tetsu Nakamura MD, PhD, Tatsuya Imanishi MD, PhD, Shingo Kanaji MD, PhD, Masashi Yamamoto MD, PhD, Kiyonori Kanemitsu MD, PhD, Kimihiro Yamashita MD, PhD, Yasuo Sumi MD, PhD, Kenichi Tanaka MD, PhD & Yoshihiro Kakeji MD, PhD

  2. Department of Surgery, Kita-harima Medical Center, Ono, Japan

    Daisuke Kuroda MD, PhD

Authors
  1. Satoshi Suzuki MD, PhD
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  2. Tetsu Nakamura MD, PhD
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  3. Tatsuya Imanishi MD, PhD
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  4. Shingo Kanaji MD, PhD
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  5. Masashi Yamamoto MD, PhD
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  6. Kiyonori Kanemitsu MD, PhD
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  7. Kimihiro Yamashita MD, PhD
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  8. Yasuo Sumi MD, PhD
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  9. Kenichi Tanaka MD, PhD
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  10. Daisuke Kuroda MD, PhD
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  11. Yoshihiro Kakeji MD, PhD
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Corresponding author

Correspondence to Satoshi Suzuki MD, PhD.

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Suzuki, S., Nakamura, T., Imanishi, T. et al. Carbon Dioxide Pneumoperitoneum Led to No Severe Morbidities for the Elderly During Laparoscopic-Assisted Distal Gastrectomy. Ann Surg Oncol 22, 1548–1554 (2015). https://doi.org/10.1245/s10434-014-4182-8

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  • DOI: https://doi.org/10.1245/s10434-014-4182-8

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