PDF(Pubmed)
Abstract：
Minimally invasive surgery has provided several clinical advantages in locally advanced gastric cancer (LAGC) care, although a consensus on its application criteria remains unclear. Surgery remains a careful choice in elderly patients, who frequently present with frailty, comorbidities, and other disabling diseases. This study aims to assess the possible advantages of laparoscopic gastric resections in elderly patients presenting with LAGC. This retrospective study analyzed a single-center series of elderly patients (≥75 years) undergoing curative resections for LAGC between 2015 and 2020. A comparative analysis of open versus laparoscopic approaches was conducted, focusing on postoperative complications, length of hospital stay (LOS), and long-term survival. A total of 62 patients underwent gastrectomy through an open or a laparoscopic approach (31 pts each). The study population did not show statistically significant differences in demographics, operative risk, and neoadjuvant chemotherapy. The laparoscopic group reported significantly minimized overall complications (45.2 vs. 71%, p = 0.039) and pulmonary complications (0 vs. 9.7%, p = 0.038) as well as a shorter LOS (8 vs. 12 days, p = 0.007). Lymph node harvest was equal between the groups, although long-term overall survival presented significantly better after laparoscopic gastrectomy (p = 0.048), without a relevant difference in terms of disease-free and disease-specific survivals. Laparoscopic gastrectomy proves effective in elderly LAGC patients, offering substantial short- and long-term postoperative benefits.
摘要：
微创手术在局部晚期胃癌（LAGC）治疗中提供了一些临床优势，尽管对其应用标准的共识仍不清楚。手术仍然是老年患者的谨慎选择，经常表现脆弱的人，合并症,和其他致残疾病。这项研究旨在评估腹腔镜胃切除术在患有LAGC的老年患者中的可能优势。这项回顾性研究分析了2015年至2020年间接受LAGC根治性切除的老年患者（≥75岁）的单中心系列。进行了开腹与腹腔镜入路的比较分析，关注术后并发症，住院时间（LOS），和长期生存。共有62例患者通过开放或腹腔镜方法进行了胃切除术（每位31例）。研究人群在人口统计学上没有显示出统计学上的显着差异，手术风险，和新辅助化疗。腹腔镜组报告显着减少了总体并发症（45.2vs.71%,p=0.039）和肺部并发症（0vs.9.7%,p=0.038)以及较短的LOS(8vs.12天,p=0.007)。两组淋巴结收获相等，尽管腹腔镜胃切除术后的长期总生存率显着改善（p=0.048），在无病生存率和疾病特异性生存率方面没有相关差异。腹腔镜胃切除术对老年LAGC患者有效，提供实质性的短期和长期术后益处。
