Abstract：
OBJECTIVE: Laparoscopic gastrectomy (LG) may have greater clinical benefits as a less invasive surgery for elderly patients with gastric cancer (GC). Therefore, we aimed to evaluate the survival benefit of LG in elderly patients with GC, especially focusing on preoperative comorbidities, and nutritional and inflammatory status.
METHODS: Data collected from 115 patients aged ≥75 years with primary GC who underwent curative gastrectomy, comprising 58 patients who underwent open gastrectomy (OG) and 57 patients who underwent LG, were retrospectively reviewed (total cohort), and 72 propensity-matched patients (matched cohort) were selected for survival analysis. The aim of the study was to determine short- and long-term outcomes, and the clinical markers to identify a population who may benefit from LG in elderly patients.
RESULTS: The complication and mortality rates as a short-term outcome in the total cohort and overall survival (OS) as a long-term outcome in the matched cohort did not differ significantly between the groups. In the total cohort, advanced tumor stage and ≥3 comorbidities were independent factors for poor prognosis in terms of OS [hazard ratio (HR)=3.73, 95% confidence interval (CI)=1.78-7.78, p<0.001 and HR=2.50, 95% CI=1.35-4.61, p<0.01, respectively]. The surgical approach was not an independent risk factor for postoperative complications (grade ≥III) and OS. In subgroup analysis of the total cohort, patients with a neutrophil-lymphocyte ratio (NLR) ≥3 in the LG group demonstrated a trend toward greater OS (HR=0.26, 95% CI=0.10-0.64, interaction p<0.05).
CONCLUSIONS: LG might offer greater survival benefits than OG in frail patients such as those with high NLR.
METHODS: Data collected from 115 patients aged ≥75 years with primary GC who underwent curative gastrectomy, comprising 58 patients who underwent open gastrectomy (OG) and 57 patients who underwent LG, were retrospectively reviewed (total cohort), and 72 propensity-matched patients (matched cohort) were selected for survival analysis. The aim of the study was to determine short- and long-term outcomes, and the clinical markers to identify a population who may benefit from LG in elderly patients.
RESULTS: The complication and mortality rates as a short-term outcome in the total cohort and overall survival (OS) as a long-term outcome in the matched cohort did not differ significantly between the groups. In the total cohort, advanced tumor stage and ≥3 comorbidities were independent factors for poor prognosis in terms of OS [hazard ratio (HR)=3.73, 95% confidence interval (CI)=1.78-7.78, p<0.001 and HR=2.50, 95% CI=1.35-4.61, p<0.01, respectively]. The surgical approach was not an independent risk factor for postoperative complications (grade ≥III) and OS. In subgroup analysis of the total cohort, patients with a neutrophil-lymphocyte ratio (NLR) ≥3 in the LG group demonstrated a trend toward greater OS (HR=0.26, 95% CI=0.10-0.64, interaction p<0.05).
CONCLUSIONS: LG might offer greater survival benefits than OG in frail patients such as those with high NLR.
摘要：
目的：腹腔镜胃切除术（LG）作为老年胃癌（GC）患者的微创手术，可能具有更大的临床益处。因此,我们旨在评估LG对老年GC患者的生存益处，特别是关注术前合并症，营养和炎症状态。
方法：从115名年龄≥75岁的原发性胃癌患者中收集数据，这些患者接受了根治性胃切除术，包括58例接受开腹胃切除术（OG）的患者和57例接受LG的患者，进行回顾性审查（总队列），选择72例倾向匹配患者(匹配队列)进行生存分析.这项研究的目的是确定短期和长期的结果，和临床标志物，以确定可能受益于老年患者LG的人群。
结果：在总队列中作为短期结局的并发症和死亡率以及在匹配队列中作为长期结局的总生存期（OS）在组间没有显著差异。在总队列中，就OS而言,晚期肿瘤分期和≥3种合并症是预后不良的独立因素[风险比(HR)=3.73,95%置信区间(CI)=1.78~7.78,p<0.001,HR=2.50,95%CI=1.35~4.61,p<0.01].手术方式不是术后并发症（≥III级）和OS的独立危险因素。在整个队列的亚组分析中，LG组中性粒细胞-淋巴细胞比值(NLR)≥3的患者表现出更高的OS趋势(HR=0.26,95%CI=0.10-0.64,交互作用p<0.05).
结论：LG可能比OG在体弱患者（如NLR较高的患者）中提供更大的生存获益。
方法：从115名年龄≥75岁的原发性胃癌患者中收集数据，这些患者接受了根治性胃切除术，包括58例接受开腹胃切除术（OG）的患者和57例接受LG的患者，进行回顾性审查（总队列），选择72例倾向匹配患者(匹配队列)进行生存分析.这项研究的目的是确定短期和长期的结果，和临床标志物，以确定可能受益于老年患者LG的人群。
结果：在总队列中作为短期结局的并发症和死亡率以及在匹配队列中作为长期结局的总生存期（OS）在组间没有显著差异。在总队列中，就OS而言,晚期肿瘤分期和≥3种合并症是预后不良的独立因素[风险比(HR)=3.73,95%置信区间(CI)=1.78~7.78,p<0.001,HR=2.50,95%CI=1.35~4.61,p<0.01].手术方式不是术后并发症（≥III级）和OS的独立危险因素。在整个队列的亚组分析中，LG组中性粒细胞-淋巴细胞比值(NLR)≥3的患者表现出更高的OS趋势(HR=0.26,95%CI=0.10-0.64,交互作用p<0.05).
结论：LG可能比OG在体弱患者（如NLR较高的患者）中提供更大的生存获益。
