title: Laparoscopy-assisted gastrectomy in the elderly: experience from a UK centre.
abstract: BACKGROUND Gastric cancer has a high incidence in the elderly in the UK, with a significant number of patients aged 75 years or more. While surgery forms the mainstay of treatment, evidence pertaining to the management of gastric cancer in the Western population in this age group is scarce. METHODS We retrospectively reviewed the outcomes of laparoscopy-assisted total and distal gastrectomies at our centre from 2005 to 2015. Patients aged 70 years or above were included in the elderly group. RESULTS A total of 60 patients underwent laparoscopy-assisted gastrectomy over a 10-year period, with a predominance of male patients. There was no significant difference in the rate of overall surgical and non-surgical complications, in-hospital mortality, operation time and length of hospital stay, between the elderly and non-elderly groups. Univariate analysis, performed for risk factors relating to anastomotic leak and surgical complications, showed that age over 70 years and higher American Association of Anesthesiologists grades are associated with a higher, though not statistically significant, number of anastomotic leaks (P = 1.000 and P = 0.442, respectively) and surgical complications (P = 0.469 and P = 0.162, respectively). The recurrence rate within the first 3 years of surgery was significantly higher in the non-elderly group compared with the elderly group (Log Rank test, P = 0.002). There was no significant difference in survival between the two groups (Log Rank test, P = 0.619). CONCLUSIONS Laparoscopy-assisted gastrectomy is safe and feasible in an elderly population. There is a need for well-designed, prospective, randomised studies with quality of life data to inform our practice in future.
authors.affiliation: Department of General Surgery, Aintree University Hospital , Liverpool , UK.
authors.forename: A
authors.initials: A
authors.lastname: Tandon
authors.affiliation: Department of General Surgery, Aintree University Hospital , Liverpool , UK.
authors.forename: I
authors.initials: I
authors.lastname: Rajendran
authors.affiliation: Department of General Surgery, Aintree University Hospital , Liverpool , UK.
authors.forename: M
authors.initials: M
authors.lastname: Aziz
authors.affiliation: MRC North West Hub for Trials Methodology Research , Liverpool , UK.|Department of Biostatistics, Institute of Translational Medicine, University of Liverpool , Liverpool , UK.
authors.forename: R
authors.initials: R
authors.lastname: Kolamunnage-Dona
authors.affiliation: Department of General Surgery, Aintree University Hospital , Liverpool , UK.|NIHR Liverpool Pancreas Biomedical Research Unit, Royal Liverpool and Broadgreen University, Hospitals NHS Trust, Department of Molecular and Clinical Cancer Medicine, University of Liverpool , Liverpool , UK.
authors.forename: Q M
authors.initials: QM
authors.lastname: Nunes
authors.affiliation: Department of General Surgery, Aintree University Hospital , Liverpool , UK.
authors.forename: M
authors.initials: M
authors.lastname: Shrotri
mesh_terms: D000230:Adenocarcinoma / Q000601:surgery*; D000328:Adult; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D057868:Anastomotic Leak / Q000453:epidemiology; D005260:Female; D005743:Gastrectomy / Q000379:methods*; D017052:Hospital Mortality; D006801:Humans; D010535:Laparoscopy / Q000379:methods*; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000453:epidemiology*; D061646:Operative Time; D011183:Postoperative Complications / Q000453:epidemiology*; D012189:Retrospective Studies; D013274:Stomach Neoplasms / Q000601:surgery*; D016896:Treatment Outcome; D006113:United Kingdom / Q000453:epidemiology
keywords: Elderly; Gastric Carcinoma; Laparoscopy-Assisted Gastrectomy