Michitaka Honda1, Hiraku Kumamaru2, Tsuyoshi Etoh3, Hiroaki Miyata4, Yuichi Yamashita5, Kazuhiro Yoshida6, Yasuhiro Kodera7, Yoshihiro Kakeji8, Masafumi Inomata3, Hiroyuki Konno9, Yasuyuki Seto10, Seigo Kitano11, Masahiko Watanabe12, Naoki Hiki13. 1. Department Minimally invasive surgical and medical oncology, Fukushima Medical University, Fukushima, Japan. 2. Department of Healthcare Quality Assessment, Graduate School of Medicine, University of Tokyo, Tokyo, Japan. 3. Department of Gastroenterological and Pediatric Surgery, Faculty of Medicine, Oita University, Oita, Japan. 4. Department of Health Policy and Management, School of Medicine, Keio University, Tokyo, Japan. 5. Department of Gastroenterological Surgery, Faculty of Medicine, Fukuoka University, Fukuoka, Japan. 6. Department of Surgical Oncology, Graduate School of Medicine, Gifu University, Gifu, Japan. 7. Department of Gastroenterological Surgery, Graduate School of Medicine, Nagoya University, Nagoya, Japan. 8. Division of Gastrointestinal Surgery, Department of Surgery, Graduate School of Medicine, Kobe University, Kobe, Japan. 9. Database Committee, the Japanese Society of Gastroenterological Surgery, Tokyo, Japan. 10. The Japanese Society of Gastroenterological Surgery, Tokyo, Japan. 11. Oita University, Oita, Japan. 12. Department of Surgery, Kitasato University School of Medicine, Sagamihara, Japan. 13. Department of Gastroenterological Surgery, Gastroenterological Center, Cancer Institute Ariake Hospital of Japanese Foundation for Cancer Research, 3-10-6 Ariake, Koto-ku, Tokyo, Japan. naoki.hiki@jfcr.or.jp.
Abstract
BACKGROUND: Laparoscopic gastrectomy (LG) might have greater clinical benefits for elderly patients as less invasive surgery; however, there is still little evidence to support its benefit. We evaluated the surgical outcomes of elderly patients in a nationwide prospective cohort study. METHODS: One hundred and sixty-nine participating institutions were identified by stratified random sampling, and were adjusted for hospital volume, type and location. During 1 year from 2014 to 2015, consecutive patients who underwent gastrectomy for gastric cancer were prospectively enrolled. 'Elderly' was defined as ≥ 75 years of age, based on the prevalence of comorbidities and the activities of daily living of patients of this age. We compared the surgical outcomes of LG to those of open gastrectomy (OG) in non-elderly and elderly patients. The primary outcome was the incidence of severe morbidities (Grade ≥ 3). RESULTS: Eight thousand nine hundred and twenty-seven patients were enrolled [non-elderly, n = 6090 (OG, n = 2602; LG, n = 3488); elderly, n = 2837 (OG, n = 1471; LG, n = 1366)]. Grade ≥ 3 complications occurred in 161 (10.9%) patients who underwent OG and 98 (7.2%) who underwent LG (p < 0.001). After adjusting for confounding factors, we confirmed that laparoscopic surgery was not an independent risk factor (odds ratio = 0.81, 0.60-1.09). OG was associated with a significantly longer median length of postoperative stay in comparison to LG (16 versus 12 days, p < 0.001). There were no significant differences in the incidence of other postoperative comorbidities. CONCLUSION: The safety of LG in elderly patients was demonstrated. LG shortened the length of postoperative hospital stay.
BACKGROUND: Laparoscopic gastrectomy (LG) might have greater clinical benefits for elderly patients as less invasive surgery; however, there is still little evidence to support its benefit. We evaluated the surgical outcomes of elderly patients in a nationwide prospective cohort study. METHODS: One hundred and sixty-nine participating institutions were identified by stratified random sampling, and were adjusted for hospital volume, type and location. During 1 year from 2014 to 2015, consecutive patients who underwent gastrectomy for gastric cancer were prospectively enrolled. 'Elderly' was defined as ≥ 75 years of age, based on the prevalence of comorbidities and the activities of daily living of patients of this age. We compared the surgical outcomes of LG to those of open gastrectomy (OG) in non-elderly and elderly patients. The primary outcome was the incidence of severe morbidities (Grade ≥ 3). RESULTS: Eight thousand nine hundred and twenty-seven patients were enrolled [non-elderly, n = 6090 (OG, n = 2602; LG, n = 3488); elderly, n = 2837 (OG, n = 1471; LG, n = 1366)]. Grade ≥ 3 complications occurred in 161 (10.9%) patients who underwent OG and 98 (7.2%) who underwent LG (p < 0.001). After adjusting for confounding factors, we confirmed that laparoscopic surgery was not an independent risk factor (odds ratio = 0.81, 0.60-1.09). OG was associated with a significantly longer median length of postoperative stay in comparison to LG (16 versus 12 days, p < 0.001). There were no significant differences in the incidence of other postoperative comorbidities. CONCLUSION: The safety of LG in elderly patients was demonstrated. LG shortened the length of postoperative hospital stay.
Entities:
Keywords:
Complications; Elderly patients; Gastric cancer; Laparoscopic surgery
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