Yoshiyuki Kiyasu, MD, Hiroshi Kusanagi, MD, Ph, D, Nobuyasu Kano. Kameda Medical Center
Recently, the safety of laparoscopy-assisted distal gastrectomy (LADG) with lymph node dissection for early stage gastric cancer is considered to be equal with open distal gastrectomy (ODG). But in the elderly, patient only, the safety of LADG compared with ODG has not been established yet. To evaluate short term surgical safety, the outcome and the postoperative course of LADG was compared with that of ODG only in the elderly.
During 2000- 2013, 70 patients with Stage I gastric cancer received radical distal gastrectomy, where LADG was undergone in 21 patients, and ODG was undergone in 49 patients. The clinicopathologic characteristics, postoperative outcomes and courses, and postoperative morbidities and mortalities were compared between these groups. Data were retrieved from the database at our hospital retrospectively.
Between LADG group and ODG group, Sex (men/ female): 12/9 vs. 23/26, Age: 81 (80-87) vs. 82 (80-86), Body mass index (BMI): 23.6 (16.7–33.3) vs. 21.9 (16.2-32.3), American Society of Anesthesiology class (class 2/ class 3): 17/4 vs. 39/10 were not significantly different. LADG group had longer operative time [220 (151-343) min vs. 181 (92-343) min, P = 0.0013], but less blood loss [70 (20–640) ml vs. 190(50-1380) ml, P = 0.0010] and shorter postoperative stay [11(9-34) days vs. 15 (8-48) days, P = 0.0093]. Postoperative morbidities and mortalities were not significantly different between these two groups.
Our data confirmed that for elderly people, the safety of LADG is not significantly different, compared with ODG. Moreover, In terms of blood loss and recovery after surgery, LADG proved to be superior to ODG, like many previous studies for younger patients.