Short-term Outcomes And Prognosis Of Laparoscopy?assisted Total Gastrectomy In Elderly Patients With Stomach Cancer

Background The aim of this study was to evaluate the short-term outcomes and prognosis of laparoscopy-assisted total gastrectomy(LTG)in elderly patients with gastric cancer.Methods The clinical data of 275 patients aged over 65 years undergoing open total gastrectomy(OTG,n = 184)or laparoscopy-assisted total gastrectomy(LTG,n = 91)were reviewed from January 2015 to August 2017 at the First Affiliated Hospital of the University of Science and Technology of China.Short-term outcomes were compared between the two groups,and risk factors for postoperative complications were explored.In addition,the 2-year overall survival(OS)and disease-free survival(DFS)were investigated for both groups.Results Except for the ASA score(P = 0.01),there was no significant difference regarding patient baselines between the two groups.Patients in the LTG group had a longer operative time(P < 0.001),less intraoperative blood loss(P = 0.004),a shorter time of resumption to a semi-liquid diet(P < 0.001)and a shorter postoperative hospital stay(P = 0.001).The incidence of pulmonary complications was significantly lower in the LTG group than in the OTG group(4.4% vs.13%,P = 0.026).The number of lymph nodes harvested in the LTG group was higher than that in the OTG group(20.7 ± 7.4 vs.17.5 ± 6.9,P = 0.001),and the proportion of patients with TNM stage Ⅲ gastric cancer was higher in the LTG group than in the OTG group(P = 0.035).There was no significant difference in the 2-year OS rate or 2-year DFS rate between the two groups(P = 0.057 and P = 0.344).Sex,age,preoperative comorbidity,intraoperative blood loss,and TNM stage were identified as independent prognostic factors for postoperative survival.Conclusion Comparing with OTG,LTG is feasible and contributes to less surgical trauma and a faster recovery after total gastrectomy.In addition,LTG contributes to a lower risk of postoperative pulmonary complications.Regarding oncological results,LTG is more effective for lymph node dissection and has a comparable long-term prognosis as OTG.