title: Laparoscopy-assisted versus open distal gastrectomy for gastric cancer in elderly patients: a retrospective comparative study.
abstract: With the current increased longevity in elderly population, surgeons can expect to operate more frequently on elderly patients with both malignancies and comorbid medical conditions. This study aimed to compare the surgical and early postoperative outcomes of laparoscopy-assisted distal gastrectomy (LADG) with those of open distal gastrectomy (ODG) for gastric cancer in patients 70 years of age or older.
  
  
  
  Retrospective analysis based on a prospectively collected database of elderly patients who underwent laparoscopy-assisted distal gastrectomy or ODG from February 2013 to January 2014. Preoperative patient baseline parameters, surgical and oncological outcomes, postoperative complications and pathologic results were analyzed in this report.
  
  
  
  Distal gastrectomy was performed for 50 patients with the age of 70 years or older, using laparoscopic surgery for 23 patients (LADG group) and open surgery for 27 patients (ODG group). The mean age of LADG group was 76.6 years and ODG group 80.0 years. The comparison between the two groups revealed statistically similar results regarding age, gender, BMI, ASA class, history of previous surgeries, CCI and pathologic characteristics. The LADG group was characterized by less intraoperative blood loss (LADG group 100 mL vs. ODG group 250 mL, P < 0.001), less narcotic use (LADG group 1 day vs. ODG group 3 days, P < 0.001), faster bowel function recovery (time to first flatus: LADG group 51.6 h vs. ODG group 67.2 h, P < 0.001; days to oral intake: LADG group 6.1 days vs. ODG group 7.9 days, P = 0.002) and shorter postoperative hospital stay (LADG group 12 days vs. ODG group 16 days, P < 0.001). There was no significant difference in postoperative complication rate (overall complication rate: LADG group 21.7 % vs. ODG group 25.9 %, P = 0.730), survival rate (P = 0.719), postoperative recurrence and metastasis rate between the patients who underwent LADG and ODG.
  
  
  
  LADG for gastric cancer is feasible, efficacious and safe in elderly patients and may be superior to conventional open resection as regards some surgical outcomes.
authors.affiliation: Department of General Surgery, Shanghai Tenth People's Hospital, Tongji University, No. 301 Middle Yanchang road, Shanghai, 200072, People's Republic of China.
authors.forename: Lijun
authors.initials: L
authors.lastname: Zheng
authors.affiliation: Department of General Surgery, Shanghai Tenth People's Hospital, Tongji University, No. 301 Middle Yanchang road, Shanghai, 200072, People's Republic of China.
authors.forename: Liesheng
authors.initials: L
authors.lastname: Lu
authors.affiliation: Department of General Surgery, Shanghai Tenth People's Hospital, Tongji University, No. 301 Middle Yanchang road, Shanghai, 200072, People's Republic of China.
authors.forename: Xun
authors.initials: X
authors.lastname: Jiang
authors.affiliation: Department of General Surgery, Shanghai Tenth People's Hospital, Tongji University, No. 301 Middle Yanchang road, Shanghai, 200072, People's Republic of China.
authors.forename: Wei
authors.initials: W
authors.lastname: Jian
authors.affiliation: Department of General Surgery, Shanghai Tenth People's Hospital, Tongji University, No. 301 Middle Yanchang road, Shanghai, 200072, People's Republic of China.
authors.forename: Zhongchen
authors.initials: Z
authors.lastname: Liu
authors.affiliation: Department of General Surgery, Shanghai Tenth People's Hospital, Tongji University, No. 301 Middle Yanchang road, Shanghai, 200072, People's Republic of China. zhoudonglei1971@163.com.
authors.forename: Donglei
authors.initials: D
authors.lastname: Zhou
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D057868:Anastomotic Leak / Q000453:epidemiology; D016063:Blood Loss, Surgical; D061887:Conversion to Open Surgery; D005260:Female; D005743:Gastrectomy / Q000379:methods*; D006333:Heart Failure / Q000453:epidemiology; D006801:Humans; D007418:Intestinal Pseudo-Obstruction / Q000453:epidemiology; D010535:Laparoscopy / Q000379:methods; D007813:Laparotomy; D007902:Length of Stay; D008297:Male; D009364:Neoplasm Recurrence, Local / Q000453:epidemiology*; D011183:Postoperative Complications / Q000453:epidemiology; D012189:Retrospective Studies; D013274:Stomach Neoplasms / Q000601:surgery*; D013530:Surgical Wound Infection / Q000453:epidemiology; D015996:Survival Rate; D016896:Treatment Outcome
keywords: Elderly patients; Gastric cancer; Laparoscopy-assisted distal gastrectomy; Open distal gastrectomy