Is Laparoscopic Gastrectomy More Advantageous for Elderly Patients Than for Young Patients with Resectable Advanced Gastric Cancer?
Adenocarcinoma
/ mortality
Adult
Age Factors
Aged
Aged, 80 and over
Blood Loss, Surgical
/ prevention & control
Female
Follow-Up Studies
Gastrectomy
/ methods
Humans
Laparoscopy
/ mortality
Male
Middle Aged
Neoplasm Staging
Operative Time
Postoperative Complications
/ mortality
Propensity Score
Retrospective Studies
Stomach Neoplasms
/ mortality
Treatment Outcome
Journal
World journal of surgery
ISSN: 1432-2323
Titre abrégé: World J Surg
Pays: United States
ID NLM: 7704052
Informations de publication
Date de publication:
07 2020
07 2020
Historique:
pubmed:
3
4
2020
medline:
26
1
2021
entrez:
3
4
2020
Statut:
ppublish
Résumé
Laparoscopic gastrectomy (LG) is now practiced widely, but it is unclear whether LG is the appropriate approach for elderly patients with resectable advanced gastric cancer. The aim of this study was to examine whether LG is more or less advantageous for elderly patients than for young patients. We collected data on 571 consecutive patients who underwent gastrectomy for pT2-4 gastric cancer between January 2001 and December 2015. After adjustment with one-to-one propensity score matching, short-term and long-term outcomes were compared between the LG and open gastrectomy (OG) groups among young (age < 70 years) and elderly (age ≥ 70 years) patients. The LG group had a significantly longer operative time (P < 0.001) and less blood loss (P < 0.001) than the OG group among young and elderly patients. There were no significant differences regarding complications. Although disease-specific survival was similar between the LG and OG groups among young and elderly patients, LG was associated with more favorable overall survival than OG only among elderly patients (hazard ratio 0.67; 95% confidence interval 0.35-1.26). Death from respiratory diseases occurred more frequently in the OG group (10.9%) than in the LG group (0%) for elderly patients (P = 0.012). LG for resectable advanced gastric cancer was not inferior to OG in terms of both short-term and long-term outcomes regardless of patient age. In elderly patients, LG may improve overall survival by reducing mortality from respiratory diseases.
Sections du résumé
BACKGROUND
Laparoscopic gastrectomy (LG) is now practiced widely, but it is unclear whether LG is the appropriate approach for elderly patients with resectable advanced gastric cancer. The aim of this study was to examine whether LG is more or less advantageous for elderly patients than for young patients.
METHODS
We collected data on 571 consecutive patients who underwent gastrectomy for pT2-4 gastric cancer between January 2001 and December 2015. After adjustment with one-to-one propensity score matching, short-term and long-term outcomes were compared between the LG and open gastrectomy (OG) groups among young (age < 70 years) and elderly (age ≥ 70 years) patients.
RESULTS
The LG group had a significantly longer operative time (P < 0.001) and less blood loss (P < 0.001) than the OG group among young and elderly patients. There were no significant differences regarding complications. Although disease-specific survival was similar between the LG and OG groups among young and elderly patients, LG was associated with more favorable overall survival than OG only among elderly patients (hazard ratio 0.67; 95% confidence interval 0.35-1.26). Death from respiratory diseases occurred more frequently in the OG group (10.9%) than in the LG group (0%) for elderly patients (P = 0.012).
CONCLUSION
LG for resectable advanced gastric cancer was not inferior to OG in terms of both short-term and long-term outcomes regardless of patient age. In elderly patients, LG may improve overall survival by reducing mortality from respiratory diseases.
Identifiants
pubmed: 32236729
doi: 10.1007/s00268-020-05486-2
pii: 10.1007/s00268-020-05486-2
doi:
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM