Laparoscopic Radical Gastrectomy In Elderly And Non-elderly Patients With Gastric Cancer: A Meta-analysis

Objective: To date,it has been unclear whether laparoscopic radical gastrectomy(LRG)is a suitable treatment for elderly patients with gastric cancer(GC).This study aimed to systematically evaluate the short-and long-term outcomes in elderly patients with GC undergoing LRG compared to non-elderly patients.Methods: A systematic search of PubMed,EMBASE,and Web of Science from January1994 to Febuary 2016 was conducted.All original studies comparing elderly to nonelderly patients with GC undergoing LRG were included by critical appraisal.The following evaluated endpoints were checked: operative time,blood loss,conversion to open surgery,harvested lymph nodes,flatus time,hospital stay,postoperative mortality,and overall 5-year survival rates.Additionally,postoperative complications were assessed including anastomotic leakage,anastomotic stenosis,wound-related complications,and pneumonia.Data synthesis and statistical analysis were carried out using Rev Man 5.3 software.Results: Six studies were selected in this analysis,which included a total of 1268 patients with GC undergoing LRG(347 were elderly patients,and 921 were non-elderly patients).Compared with non-elderly patients,elderly patients showed a later passage of flatus [WMD=0.42,95%CI(0.22,0.61),P<0.05],longer postoperative hospital stay[WMD=1.94,95%CI(0.73,3.14),P<0.05],higher postoperative complication rate[OR=1.48,95%CI(1.04,2.09,P<0.5],and an especially higher pneumonia rate[OR=8.13,95%CI(1.66,39.92,P<0.05].The operative time[WMD=9.42,95%CI(-22.42,3.59),P=0.16],intraoperative blood loss [WMD=-31.28,95%CI(-72.59,10.03);P=0.14],conversion to open surgery[OR=2.23,95%CI(0.81,6.15),P=0.12],postoperative mortality[OR=8.47,95%CI(0.95,75.62);P=0.06],anastomotic leakage[OR=1.36,95%CI(0.31,6.02),P=0.68],anastomotic stenosis[OR=1.11,95%CI(0.4,3.11);P=0.84],wound-related complications[OR=1.42,95%CI(0.51,3.95),p=0.51],and overall 5-year survival rates [HR=9.21,95%CI(0.18,468.27),P=0.27]between the elderly and non-elderly patients were similar.Conclusions: Although the postoperative complication of LRG in elderly patients was higher than non-elderly patients,overall 5-year survival rates were not significantly different between groups,which indicated the similar oncological outcome.