title: Laparoscopic gastrectomy for gastric cancer in the elderly patients.
abstract: BACKGROUND
  This study aimed to investigate the short-term surgical outcomes of laparoscopic gastrectomy for gastric cancer in elderly patients in order to determine the safety, feasibility, and risk factors for postoperative complications associated with this procedure.
  
  
  METHODS
  We retrospectively investigated 208 patients who underwent laparoscopic gastrectomy for gastric cancer between January 2007 and September 2014. After excluding 15 patients with unusual medical histories or surgical treatments, 193 were selected for this cohort study. We divided the patients into two cohorts: elderly patients (≥75 years old) and non-elderly patients (<74 years old). We compared these cohorts with respect to clinicopathological characteristics and intraoperative and postoperative parameters.
  
  
  RESULTS
  The overall complication rates were 11.4% (8 of 70 patients) in the elderly cohort and 8.1% (10 of 123 patients) in the non-elderly cohort (P = 0.449). In a univariate analysis, Charlson comorbidity index (CCI) of ≥3, American Society of Anesthesiologists (ASA) score of 3, operative time of ≥330 min, and intraoperative blood loss of ≥50 ml were found to correlate significantly with postoperative complications. In a multivariate analysis, CCI of ≥3 (P = 0.034), ASA score of 3 (P = 0.019), and intraoperative blood loss of ≥50 ml (P = 0.016) were found to be independent risk factors of postoperative complications. In contrast, age was not found to significantly affect the risk of postoperative complications.
  
  
  CONCLUSIONS
  Laparoscopic gastrectomy for gastric cancer can be successfully performed in elderly patients with an acceptable complication rate. This study suggested that high CCI, ASA score, and intraoperative blood loss volume were identified as independent predictors of postoperative complications after laparoscopic gastrectomy for gastric cancer.
authors.affiliation: Department of Surgery, Machida Municipal Hospital, 2-15-41 Asahicho, Machida, Tokyo, 194-0023, Japan.
authors.forename: Muneharu
authors.initials: M
authors.lastname: Fujisaki
authors.affiliation: Department of Surgery, Machida Municipal Hospital, 2-15-41 Asahicho, Machida, Tokyo, 194-0023, Japan. shinohara@jikei.ac.jp.
authors.forename: Toshihiko
authors.initials: T
authors.lastname: Shinohara
authors.affiliation: Department of Surgery, Machida Municipal Hospital, 2-15-41 Asahicho, Machida, Tokyo, 194-0023, Japan.
authors.forename: Nobuyoshi
authors.initials: N
authors.lastname: Hanyu
authors.affiliation: Department of Surgery, Machida Municipal Hospital, 2-15-41 Asahicho, Machida, Tokyo, 194-0023, Japan.
authors.forename: Susumu
authors.initials: S
authors.lastname: Kawano
authors.affiliation: Department of Surgery, Machida Municipal Hospital, 2-15-41 Asahicho, Machida, Tokyo, 194-0023, Japan.
authors.forename: Yujiro
authors.initials: Y
authors.lastname: Tanaka
authors.affiliation: Department of Surgery, Machida Municipal Hospital, 2-15-41 Asahicho, Machida, Tokyo, 194-0023, Japan.
authors.forename: Atsushi
authors.initials: A
authors.lastname: Watanabe
authors.affiliation: Department of Surgery, The Jikei University School of Medicine, Tokyo, Japan.
authors.forename: Katsuhiko
authors.initials: K
authors.lastname: Yanaga
mesh_terms: D000359:Aftercare; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D005743:Gastrectomy / Q000379:methods*; D006801:Humans; D015994:Incidence; D007564:Japan / Q000453:epidemiology; D010535:Laparoscopy / Q000379:methods*; D008297:Male; D008875:Middle Aged; D061646:Operative Time; D011183:Postoperative Complications / Q000453:epidemiology*; D012189:Retrospective Studies; D012307:Risk Factors; D013274:Stomach Neoplasms / Q000401:mortality / Q000601:surgery*; D015996:Survival Rate / Q000639:trends
keywords: American Society of Anesthesiologists; Charlson comorbidity index; Elderly patients; Gastric cancer; Laparoscopic surgery