Laparoscopic Gastrectomies for Cancer in the Elderly. Short and Long Term Outcomes

Marta Jimenez Toscano, PHD, Dulce Momblan, MD, Salvadora Delgado, Jorge Ordonez, Juan Carlos Baanante, Almenara Raul, Raquel Bravo, Maria Fernandez Hevia, Antonio Lacy. Hospital Clinic, Barcelona

Background. The longer life expectancy encourages us to perform demanding laparoscopic procedures in fragile group of patient. Nevertheless, the age should not be exclusion criteria for oncological resection. We evaluate our results in the laparoscopic treatment of gastric cancer on elderly patients.

Materials and methods. Retrospective analysis, of a prospective cancer gastric database, at the Clinic Hospital in Barcelona. The postoperative outcomes as well as possible risk factors for poor postoperative or long-term results are evaluated.

Results 67 patients over 75 years old (41, 10%) were included from June 2006 to May 2015. The mean age was 80 years old (sd 4,01, 75-92), with a male/female rate of 1,48/1, Charlson Comorbidity Index of 6,9 (sd 1,4, 4-11,2). Most of them were ASA II/III with advanced gastric cancer. The procedure was achieved with curative intention in 82.1%, requiring a total gastrectomy in half of them and a D2 lymphadenectomy in 50.7% (n: 34). The mean operative time was 257, 9 minutes (210-318). The postoperative complications related with the surgical procedure were 20, 9% (n: 14). The mortality rate was 4, 5 % (n: 3). Overall survival was 57.56 months (sd 4.8, 48.11-66.98). The Charlson Comorbidity Index and ASA Score had significant relation with postoperative complications but only the TNM stage was related with worse survival.

Conclusions. The gastric cancer laparoscopic surgeries are feasible and safe in patients over 75 years old with an acceptable complication rate. The Charlson Comorbidity Index and the ASA score were the only two factors related with poor postoperative outcomes

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