Carbon dioxide pneumoperitoneum led to no severe morbidities for the elderly during laparoscopic-assisted distal gastrectomy.
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.
Division of Gastrointestinal Surgery, Department of Surgery, Graduate School of Medicine, Kobe University, Kobe, Hyogo, Japan, ss147@med.kobe-u.ac.jp.
Satoshi
S
Suzuki
Tetsu
T
Nakamura
Tatsuya
T
Imanishi
Shingo
S
Kanaji
Masashi
M
Yamamoto
Kiyonori
K
Kanemitsu
Kimihiro
K
Yamashita
Yasuo
Y
Sumi
Kenichi
K
Tanaka
Daisuke
D
Kuroda
Yoshihiro
Y
Kakeji
D000230:Adenocarcinoma / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D000328:Adult; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D002245:Carbon Dioxide; D016022:Case-Control Studies; D005260:Female; D005500:Follow-Up Studies; D005743:Gastrectomy / Q000401:mortality*; D006801:Humans; D010535:Laparoscopy / Q000379:methods*; D008297:Male; D008875:Middle Aged; D009017:Morbidity; D009367:Neoplasm Staging; D011027:Pneumoperitoneum; D011183:Postoperative Complications; D011379:Prognosis; D013274:Stomach Neoplasms / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D015996:Survival Rate; D055815:Young Adult
D002245:Carbon Dioxide