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 Hiki

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5 Citations (Scopus)

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.

Original languageEnglish
Pages (from-to)845-852
Number of pages8
JournalGastric Cancer
Volume22
Issue number4
DOIs
Publication statusPublished - 2019 Jul 12

Keywords

  • Complications
  • Elderly patients
  • Gastric cancer
  • Laparoscopic surgery

ASJC Scopus subject areas

  • Oncology
  • Gastroenterology
  • Cancer Research

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    Honda, M., Kumamaru, H., Etoh, T., Miyata, H., Yamashita, Y., Yoshida, K., Kodera, Y., Kakeji, Y., Inomata, M., Konno, H., Seto, Y., Kitano, S., Watanabe, M., & Hiki, N. (2019). Surgical risk and benefits of laparoscopic surgery for elderly patients with gastric cancer: a multicenter prospective cohort study. Gastric Cancer, 22(4), 845-852. https://doi.org/10.1007/s10120-018-0898-7