Laparoscopic gastric cancer surgery for 65 age and elderly patients: a single center experience
Year 2022,
Volume: 39 Issue: 2, 434 - 437, 18.03.2022
Akile Zengin
,
Yusuf Murat Bağ
,
Mehmet Can Aydın
,
Fatih Sümer
,
Cuneyt Kayaalp
Abstract
Aim: Therapeutic modalities for elderly gastric cancer (GC) patients have enlarged with extended life expectancy. The aim of this study was to investigate the outcomes of surgical therapies for GC patients of age 65 and older with a single center experience.
Materials and methods: Eighty-eight patients who underwent laparoscopic surgery for GC were included in the study. The relationships between surgical methods and clinicopathological or prognostic features were analyzed.
Results: The median age of the patients was 72(65-91)years. Sixty patients (75%) were male. The median BMI was 25 kg/m2 (17.5-42). The most common ASA score was 2 (n=58, 72.5%) and tumors were mostly localized in the distal 1/3 of the stomach (n=39, 48.7%). The median CEA and CA19-9 levels were 1.94 ng/ml(0.07-93.8)and 10IU/ml (0.05-449.3), respectively. Eleven patients (13.8%) hadprevious abdominal surgery history. The most common operation type was subtotal gastrectomy (n=33, 41.3%). The median operation time was 300 min (45-720) and the median intraoperative blood loss was 100 ml (0-800). There were eleven conversion (13.8%). The median first time to oral intake was 2 days (1-10) and length of hospital stay was 7 days (1-48). Postoperative serious complications occurred in fourteen (17.5%) patients. The mean of retrieved lymph node was 30.27 ± 17.08. The most common pathological T stage was T4 (53.75%). The mediantime to chemotherapy was 41 days (6-220).
Conclusion:Laparoscopic gastric surgery is a safe and feasible method that can be performed in elderly patients with appropriate oncological principles. The risk of surgery is substantially higher in elderly patients.Therefore, maximal attention should be paid to perioperative care for the prevention and treatment of perioperative complications.
References
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Year 2022,
Volume: 39 Issue: 2, 434 - 437, 18.03.2022
Akile Zengin
,
Yusuf Murat Bağ
,
Mehmet Can Aydın
,
Fatih Sümer
,
Cuneyt Kayaalp
References
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- 2. Shimada S, Sawada N, Oae S, Seki J, Takano Y, Ishiyama Y, et al. Safety and curability of laparoscopic gastrectomy in elderly patients with gastric cancer. Surg Endosc. 2018;32:4277–83.
- 3. Sheng S, Chen Y, Li C. Outcomes of laparoscopic total gastrectomy for elderly gastric cancer patients. J Cancer. 2018;9(23):4398-403.
- 4. Suematsu H, Kunisaki C, Miyamato H, Sato K, Sato S, Tanaka Y, et al. Laparoscopic Total Gastrectomy for Gastric Cancer in Elderly Patients. In Vivo. 2020;34:2933–9.
- 5. Pan Y, Chen K, Yu W, Maher H, Wang S, Zhao H, et al. Laparoscopic gastrectomy for elderly patients with gastric cancer: A systematic review with meta-analysis. Medicine (Baltimore). 2018; 97:e0007.
- 6. Li Z-Y, Chen J, Bai B, Xu S, Song D, Lian B, et al. Laparoscopic gastrectomy for elderly gastric-cancer patients: comparisons with laparoscopic gastrectomy in non-elderly patients and open gastrectomy in the elderly. Gastroenterol Rep. 2021;9:146–53.
- 7. Zhou C-J, Chen F-F, Zhuang C-L, Pang W-Y, Zhang F-Y, Huang D-D, et al. Feasibility of radical gastrectomy for elderly patients with gastric cancer. Eur J Surg Oncol EJSO. 2016;42:303–11.
- 8. Wolford DD, Ward MA. Laparoscopic Feeding Jejunostomy and Gastrostomy. Tech Minim Invasive Surg. 2021. pp 479-89.
- 9. Navarra G, Musolino C, Venneri A, De Marco ML, Bartolotta M. Palliative antecolic isoperistaltic gastrojejunostomy: a randomized controlled trial comparing open and laparoscopic approaches. Surg Endosc Interv Tech. 2006 Dec 1;20:1831–4.
- 10. Arru L, Azagra JS, Facy O, Makkai-Popa ST, Poulain V, Goergen M. Totally laparoscopic 95 % gastrectomy for cancer: technical considerations. Langenbecks Arch Surg. 2015 Apr;400:387–93.
- 11. Zengin A, Bag YM, Aydin MC, Kayaalp C. Is jejunoduodenostomy better than jejunogastrostomy in laparoscopic gastrectomy with jejunal interposition ? Laparoscopic Endoscopic Surgical Science (LESS). 2020;27:169-73.
- 12. Dindo D, Demartines N, Clavien P-A. Classification of surgical complications: a new proposal with evaluation in a cohort of 6336 patients and results of a survey. Ann Surg. 2004;240:205-13.
- 13. Zengin A, Bag YM, Aydin MC, Kayaalp C. Conversion in laparoscopic gastric cancer surgery a highlight on the abdominal access. Ann Med Res. 2021;28:1213–6.
- 14. Huang C-M, Tu R-H, Lin J-X, Zheng C-H, Li P, Xie J-W, et al. A scoring system to predict the risk of postoperative complications after laparoscopic gastrectomy for gastric cancer based on a large-scale retrospective study. Medicine (Baltimore). 2015;94:e812.
- 15. Park J-M, Jin S-H, Lee S-R, Kim H, Jung IH, Cho YK, et al. Complications with laparoscopically assisted gastrectomy: multivariate analysis of 300 consecutive cases. Surg Endosc. 2008;22:2133–9.
- 16. Miki Y, Tokunaga M, Tanizawa Y, Bando E, Kawamura T, Terashima M. Perioperative risk assessment for gastrectomy by surgical Apgar score. Ann Surg Oncol. 2014;21:2601–7.
- 17. Yamamoto M, Okuda J, Tanaka K, Kondo K, Asai K, Kayano H, et al. Effect of previous abdominal surgery on outcomes following laparoscopic colorectal surgery. Dis Colon Rectum. 2013;56:336–42.
- 18. Lin J-X, Huang C-M, Zheng C-H, Li P, Xie J-W, Wang J-B, et al. Surgical outcomes of 2041 consecutive laparoscopic gastrectomy procedures for gastric cancer: a large-scale case control study. PLoS One. 2015;10:e0114948.
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- 20. Yue F, Geng X. Impact of conversion during laparoscopic gastrectomy on outcomes of patients with gastric cancer. J BU Off J Balk Union Oncol. 2017;22:926–31.