Efficacy of totally laparoscopic distal gastrectomy for gastric cancer in elderly patients

Abstract

Elderly patients are often considered as high-risk for major abdominal surgery due to reduced functional reserve and increased comorbidities. We herein evaluated the efficacy of totally laparoscopic distal gastrectomy (TLDG) in elderly patients with gastric cancer by measuring the postoperative systemic responses and postoperative analgesic consumption. A total of 102 patients with gastric cancer [57 who underwent TLDG and 45 who underwent laparoscopy-assisted distal gastrectomy (LADG)] were enrolled in this study. The patients were classified as elderly (aged ≥75 years) and non-elderly (aged <75 years) groups. The surgical outcome and postoperative analgesic consumption were evaluated. The elderly group exhibited a higher incidence of comorbidities and a longer postoperative hospital stay compared with those of younger patients, although there was no difference in the incidence of postoperative complications. In addition, the total consumption of additional analgesics until postoperative day 5 in patients who underwent TLDG was significantly lower compared with that in patients who underwent LADG in the elderly group; there was no such difference in the non-elderly group. The results suggested that TLDG was better for the management of postoperative pain in elderly patients with gastric cancer, who exhibit the highest mortality rates in the adult surgical population.

Keywords: cosmetic outcome; early outcome; elderly patients; gastric cancer; laparoscopy-assisted distal gastrectomy.

Figure 1.

Postoperative view of the surgical wounds 6 months after gastrectomy. (A) Laparoscopy-assisted distal gastrectomy. (B) Totally laparoscopic distal gastrectomy.

Figure 1.

Postoperative view of the surgical wounds 6 months after gastrectomy. (A) Laparoscopy-assisted distal gastrectomy. (B) Totally laparoscopic distal gastrectomy.

Figure 2.

Comparison of postoperative white blood cell count, levels of C-reactive protein, body temperature and heart rate between the TLDG and LADG groups. WBC, white blood cell count; CRP, C-reactive protein; POD, postoperative day; LADG, laparoscopy-assisted distal gastrectomy; TLDG, totally laparoscopic distal gastrectomy. *P<0.05 for TLDG vs. LADG.