Laparoscopy-assisted Versus Open Distal Gastrectomy For Gastric Cancer In Elderly Patients: A Retrospective Comparison Of The Short-term Outcomes

Background As our country has gradually stepped into an aging society,the proportion of old people is rising year by year,the prealence of elderly gastric cancer and other complications also increase,bringing a certain degree of influence surgical treatment.Currently there is a problem existing in the choice of the ways of elderly patients with gastric cancer surgery.This study aimed to evaluate the feasibility of LADG by comparing the surgical and early perioperative outcomes of laparoscopy-assisted distal gastrectomy(LADG)with those of open distal gastrectomy(ODG)for gastric cancer in patients 60 years of age or older.Methods The analysis result was shown in this study,based on the retrospectively collected database of elderly patients who underwent laparoscopy-assisted distal gastrectomy or ODG from January 2013 to November 2015 in XX Hospital.Preoperative patient baseline parameters,surgical and oncological outcomes,postoperative complications and pathologic results were analyzed in this report.By comparing the two groups in the index to judge the difference of laparoscopic assisted in elderly patients with gastric cancer radical short-term clinical effects.Results Distal gastrectomy was performed for 98 patients with the age of 60 years or older,using laparoscopic surgery for 42 patients(LADG group)with the mean age 67.9 years old,28 cases of male vs.female 14 cases,and open surgery for 27 patients(ODG group)with the mean age 69.9 years old,36 cases of male vs.female 20 cases.The mean BMI of LADG group was 23.3±3.7 kg/㎡ and ODG group 23.0±3.4kg/㎡.Incidence of preoperative complications is 38.10%(LADG group)、46.43%(ODG group)respectively.The comparison between the two groups revealed statistically similar results regarding age,gender,BMI and Incidence of preoperative complications.In perioperative outcomes,no significant difference was revealed between two groups in the constitution of digestive tract reconstruction(P = 0.120),the postoperative using dose of pethidine hydrochloride(LADG 112.5±46.3mg,ODG 158.3±108.8 mg,P = 0.233),the incidence of postoperative complications(7.14% LADG,ODG 7.14%,P = 0.186).However,compared to the ODG group,the LADG group was characterized by longer operative time(LADG 213.6±42.6min,ODG 184.2±59.4min,P = 0.008),less intraoperative blood loss(LADG 118.3±26.5 ml,ODG 142.5±43.1 ml,P = 0.001),smaller WBC changes(LADG 4.58±3.39×109/L,ODG 6.17±3.74×109/L,P = 0.002)and PLT changes(LADG 27.74±56.55×109/L,ODG 49.9±50.38 ×109/L,P = 0.043)variation,faster recovery of gastrointestinal function(first exhaust time LADG 4.4±1.1 d,ODG 5.2±1.3 d,P = 0.002)and shorter postoperative hospital stay(LADG 12.9±6.0 d,ODG 18.3±13.3d,P=0.009).On oncology,number of lymph node removed has no difference between the two groups(LADG 25.8±12.1,ODG 31.7±16.6,P = 0.052),but the significant imparity was shown in the mean size of tumor(LADG 3.6±2.6 cm,ODG 5.4±2.6 cm,P < 0.05),similarly in the mean stage of T(LADG 2.9±1.4,ODG 3.9±1.1,P < 0.001)Conclusion Despite the operative time of laparoscopic-assisted distal gastrectomy is longer than open distal gastrectomy,but its intraoperative blood loss and postoperative recovery was better than traditional open distal gastrectomy,so laparoscopic-assisted distal gastrectomy is safe and feasible in the treatment of gastric cancer in elderly patients.