Efficacy Of Laparoscopic Assisted Radical Gastrectomy For Gastric Cancer In Elderly Patients

Objective: To explore the safety,feasibility and curative effect of laparoscopic surgery for elderly patients with advanced gastric cancer.Methods: A retrospective analysis of the clinical data of Dalian Medical University Second Affiliated Hospital of general surgery from January 2005 to May2015 for 117 patients over 75 years of age progression in patients with gastric cancer,before surgery,all patients were by endoscopy and pathology confirmed that preoperative confirmed for advanced gastric cancer,the 73 cases underwent laparoscopic gastric cancer radical operation,defined as laparoscopic group;the other44 patients line traditional open gastric cancer radical operation,and defined as open group.The general situation,classification,Related indexes in operation,postoperative recovery and postoperative complications were compared between the laparoscopic group and the open group.Statistical analysis of data using Prism GraphPad 5 statistical software,Clinical data,operation related index,postoperative relevant indicators of the test measurement data using mean ± standard deviation((?)±s)said,The rank sum test of the independent sample is used to compare the measurement data of the normal distribution.Count data to constitute a ratio(percentage),compared with the X2 test.Test level are selected ?=0.05.Results: Laparoscopic group and open group cases in gender,age,American Society of anesthesiologists in patients with preoperative risk score ASA classification,preoperative comorbidities constitute ratio showed no significant difference(P > 0.05).During the operation,the average number of lymph node dissection in laparoscopic group and open group were(17.5±8.5),(14.4±9.4),Statistical analysis showed that the number of lymph node dissection in laparoscopic group was significantly higher than that in open group(P<0.05).There was no significant difference in the maximal diameter,tumor location,clinical stage and pathological type of the patients in the laparoscopic group and the open group(P>0.05).In addition,the length of incision in the laparoscopic group was significantly less than that in the open group(P<0.0001),the mean value was(6.6 ± 1.2),(19.6 ± 1.5)cm.the amount of bleeding in laparoscopic group was significantly less than that in the open group(P<0.0001),the mean value was(124.7±32.1),(335.6±114.1)ml.In laparoscopic group and open group,the average length of operation was(203 ± 45.9),(241.1 ± 68.3)minutes,statistical analysis showed that laparoscopic group was significantly less than the open group(P=0.002).There was no significant difference in the surgical margins,intraoperative complications,mortality,operative methods,and reconstruction of the gastrointestinal tract in the laparoscopic group and the open group(P>0.05).Postoperative recovery,patients in the laparoscopic group were significantly earlier than the open group(P<0.0001),the average number of days was(1.3±0.4),(2±0.6)days.In the postoperative recovery of gastrointestinal function,the laparoscopic group was significantly faster than the open group(P<0.0001),the average postoperative exhaust time was(3.2 ± 0.4),(4.5 ± 0.8)days.The average time of patients in the laparoscopic group and laparotomy group of patients with postoperative advanced liquid food respectively(4.0 ± 0.5),(3.2 ± 0.6)days.The statistic result shows that the laparoscopic group was significantly less than the laparotomy group(P < 0.0001).In addition,the number of hospital stay in laparoscopic group was significantly less than that in open group(P=0.007),and the mean values of the two groups were(20.7 ± 10.1),(24 ± 9)days.Patients in the laparoscopic group were significantly less than the open group(P=0.0237).There wasno significant difference in the postoperative mortality,postoperative recurrence,urinary tract infection,postoperative recurrence,and postoperative metastasis of the patients in the laparoscopic group and the open group.Conclusions: This study showed that surgery in the elderly patients(at the age of 75 years or over)in advanced gastric cancer is safe and feasible laparoscopic assisted radical gastrectomy for gastric cancer,The patients in Intraoperative indicators and postoperative recovery index analysis.The results showed that laparoscopic gastric cancer surgery compared with the previous traditional open gastric cancer radical operation with small incision surgery,intraoperative hemorrhage and lymph node dissection range,short operation time,little pain,postoperative recovery advantages of fast,short length of hospital stay,With the continuous development and progress of anesthesia monitoring,surgical techniques,surgical instruments and imaging systems,it is believed that the application of laparoscopic assisted radical gastrectomy for gastric cancer has a good prospect in the application of advanced gastric cancer patients.