Short- and Long-Term Outcomes After Laparoscopic Versus Open Total Gastrectomy for Elderly Gastric Cancer Patients: a Propensity Score-Matched Analysis.
BACKGROUND
To date, it has been unclear whether laparoscopic-assisted total gastrectomy (LTG) was a suitable treatment for elderly patients (aged 65 years and older) with gastric cancer. The aim of the present study was to clarify the value of LTG in the elderly using a propensity score matching method.


METHODS
We prospectively collected data from 675 elderly gastric cancer patients who underwent total gastrectomies at our institution between January 2002 and February 2012. Propensity score matching was applied at a ratio of 1:1 to compare the LTG and open total gastrectomy (OTG) groups. The operation results, hospital courses, and survival rates were compared between the matched groups.


RESULTS
The LTG group had a significantly shorter mean operating time (194 vs. 267 min, P < 0.001) and significantly less intraoperative blood loss (92 vs. 204 ml, P < 0.001). The total number of collected lymph nodes was similar in the two groups. Postoperatively, the length of hospital stay was shorter in the LTG group than in the OTG group (median 14.4 vs. 16.6 days; P = 0.001); however, no significant intergroup differences were found in morbidity or mortality. Furthermore, the 3-year overall survival (OS) rate was similar between the two groups (P = 0.517).


CONCLUSIONS
LTG for elderly gastric cancer is feasible and safe with acceptable oncologic outcomes. Therefore, patient age alone should not be considered a contraindication in the decision between LTG and OTG treatment options. A high-volume prospective study is needed to confirm this rationale.
Department of Gastric Surgery, Fujian Medical University Union Hospital, Fuzhou, Fujian Province, China.
Jun
J
Lu
Department of Gastric Surgery, Fujian Medical University Union Hospital, Fuzhou, Fujian Province, China. hcmlr2002@163.com.
Chang-Ming
CM
Huang
Department of Gastric Surgery, Fujian Medical University Union Hospital, Fuzhou, Fujian Province, China.
Chao-Hui
CH
Zheng
Department of Gastric Surgery, Fujian Medical University Union Hospital, Fuzhou, Fujian Province, China.
Ping
P
Li
Department of Gastric Surgery, Fujian Medical University Union Hospital, Fuzhou, Fujian Province, China.
Jian-Wei
JW
Xie
Department of Gastric Surgery, Fujian Medical University Union Hospital, Fuzhou, Fujian Province, China.
Jia-Bin
JB
Wang
Department of Gastric Surgery, Fujian Medical University Union Hospital, Fuzhou, Fujian Province, China.
Jian-Xian
JX
Lin
Department of Gastric Surgery, Fujian Medical University Union Hospital, Fuzhou, Fujian Province, China.
Qi-Yue
QY
Chen
Department of Gastric Surgery, Fujian Medical University Union Hospital, Fuzhou, Fujian Province, China.
Long-Long
LL
Cao
Department of Gastric Surgery, Fujian Medical University Union Hospital, Fuzhou, Fujian Province, China.
Mi
M
Lin
D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D005743:Gastrectomy; D006801:Humans; D010535:Laparoscopy; D008297:Male; D057216:Propensity Score; D011446:Prospective Studies; D013274:Stomach Neoplasms / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D015996:Survival Rate; D013997:Time Factors; D016896:Treatment Outcome
Elderly patients; Gastric cancer; Laparoscopic total gastrectomy; Propensity-matched study; Survival