The average life expectancy of the Japanese is 79 years in males and 85 in females; accordingly Japan is among countries with the longest life expectancy. Malignant neoplasm is the most prevalent cause of deaths, while gastric cancer ranks high among malignant tumors. We encounter quite a few opportunities to operate on elderly patients for gastric cancer.
Subjects and Methods
We studied the safety of laparoscope-assisted distal gastrectomy (LADG) for gastric cancer in elderly patients aged 75 years or older. In our institution, there were 60 cases that received such operations during the 4-year period from September 2004 to August 2008 and 13 cases of them were 75 years old or older.
Group A included patients aged 74 years or younger (young old patients), while group B 75 years or older (old old patients). There was no significant difference in BMI between the two groups: the median value in group A was 22.5 (mean 21.6); and that in group B was 22.2 (mean 21.7). No significant difference was found in the disease stage nor in the extent of lymph node dissection between the two groups. (following the Japan Handling Rules for Gastric Cancer)
There was no difference in the operation time nor in the amount of bleeding between the groups: the median operation time in group A, 298 min (mean 315 min), in group B, 293 min (mean 291 min); the median amount of bleeding in group A, 103 mg (mean 184 mg), in group B, 145 mg (mean 137 mg). Postoperative complications occurred in 4 cases in group A (8.5%) and 1 in group B (7.7%), showing no higher incidence in old old patients.
The frequency of postoperative analgetic use showed no difference between the groups: 1.13 times on the average in group A; and 0.62 in group B. There was no difference in the first walk after operations between the groups: day 1.65 in group A; and day 1.92 in group B. Flatus was observed on day 2.41 in group A and day 3.08 in group B or the old old group, the difference being significant.
However, most patients in both groups could take water on day 12 (mean 14) and start to ingest food on day 4 as scheduled in the critical path of our hospital.
There was no difference in the postoperative stay in hospital between the age groups; 12 days (mean 14) in group A; and 13 (mean 15.3) in group B.
No recurrence of the cancer has been observed in either group at the present moment.
We consider LADG is a safe operative procedure for elderly patients.
Program Number: P315