| Objective:To compare the clinical efficacy of laparoscopy and laparotomy in the treatment of super-aged patients with gastric cancer,and to explore the postoperative compli-cations and survival status.Methods:The clinicopathological data of 92 patients with gastric cancer aged 80 years or older who were diagnosed and underwent surgical treatment in the first affiliated Hospital of Nanchang University from January 2013 to December 2018 were retrospectively analyzed.They were divided into laparoscopy group(n = 54)and laparotomy group(n = 38)according to the operation method..The data of clinical characteristics,co-morbidity,surgical data,pathological data,short-term curative effect,postoperative complications and survival of the two groups were compared and analyzed with SPSS 24.0 statistical software.Then sum up the clinical characteristics of super elderly patients with gastric cancer,and explore the laparoscopic surgical treatment of elderly patients with gastric cancer in the short-term and long-term efficacy.Results:The Characters of super-aged patients with gastric cancer were poorer preoperative nutritional status,more comorbidities,and mostly male.Tumors characters was mostly located in lower third of the stomach,and was mostly poorly differentiated adenocarcinoma.The operative time of the laparoscopic group was longer than that of the laparotomy group,but there was no significant difference between the two groups.The laparoscopic group was less than the laparotomy group in terms of blood loss,postoperative venting time,postoperative eating time,and postoperative hospital stay,and the difference between two groups was statistically significant(P<0.05).Postoperative complications occurred in 19 patients(20.6%),the overall incidence of complications in the laparotomy group was significantly higher than that in the laparoscopic group(34.2% vs 11.1%,P=0.007).Univariate analysis showed that agewas not a risk factor for postoperative complications in super-aged patients with gastric cancer,but the number of comorbidities(χ2=6.939,P=0.008)and surgical method(χ2=7.263,P=0.007)were significantly related to the postoperative complications.Multivariate analysis showed that only three or more comorbidities were independent risk factor for postoperative complications in super-aged patients with gastric cancer(OR=0.135,95% CI:0.023-0.781,P=0.025).The overall survival rate was 60.5% at 73 months in 81 patients who underwent radical resection without surgery-related death.The mean survival time of laparoscopic group and laparotomy group were 51.1±5.0 and 30.1±3.8 months,respectively.The 3-year cumulative overall survival rate and 3-year recurrence-free survival rate in the laparoscopic group were significantly higher than those in the laparotomy group,and the difference between two groups was statistically significant(P<0.05).Univariate analysis showed that the depth of tumor invasion(χ2=5.429,P=0.020)and surgical method(χ2=4.234,P=0.040)were the risk factors for postoperative survival time in super-aged patients with gastric cancer.Multivariate analysis showed that only the depth of tumor invasion was an independent risk factor for postoperative survival time in super-aged patients with gastric cancer(OR=8.879,95% CI:1.023-77.085,P=0.048).Conclusion:Laparoscopic surgery is safe and effective in super-aged patients with gastric cancer,and its short-term efficacy is obviously superior to that of laparotomy surgery.However,the long-term efficacy of laparoscopic surgery needs to be verified by a large sample of multicenter prospective clinical studies.There are many comorbidities in super-elderly patients with gastric cancer,which increases the risk of postoperative complications.In order to improve the surgical safety and clinical efficacy,we should pay more attention to the perioperative management of co-morbidity. |
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