Abstract
The aim of this meta-analysis was to determine the feasibility of laparoscopic gastrectomy (LG) for elderly gastric cancer patients by comparing laparoscopic and conventional open gastrectomies (OG). Comprehensive search of the PubMed, EMBASE, and Cochrane Library databases revealed nine non-randomized controlled studies that compared LG and OG in elderly gastric cancer patients We then analyzed dichotomous or continuous parameters using odds ratios (ORs) or weighted mean differences (WMDs). Overall survival was estimated using hazard ratios (HRs) with a fixed effects or random effects model. We observed that the age distribution was similar between the LG and OG patient groups (WMD -0.22 95% CI, -1.26−0.82). LG patients experienced less blood loss (WMD -119.14 95% CI, -204.17−-34.11) and had shorter hospital stays (WMD -3.48 95% CI, -5.41−-1.56), but endured longer operation times (WMD 10.87 95% CI, 2.50−19.24). Postoperatively, LG patients exhibited lower incidences of postoperative morbidities (OR 0.59 95% CI, 0.43−0.79), surgery related morbidities (OR 0.58 95% CI, 0.41−0.81) and systemic morbidities (OR 0.56 95% CI, 0.38−0.82). We observed no differences between the LG and OG patient groups regarding anastomotic leakage (OR 0.69 95% CI, 0.34−1.41), mental disease (OR 0.72 95% CI, 0.37−1.41) and long term effects (HR 0.98 95% CI, 0.74−1.32). We therefore conclude that laparoscopic gastrectomy might be technically feasible for elderly gastric cancer patients.
Highlights
A recent multicenter randomized and controlled trial by Hu et al demonstrated that laparoscopic gastrectomy (LG) with D2 lymph node dissection was more feasible than the conventional open distal gastrectomy for www.impactjournals.com/oncotarget advanced gastric cancer patients [1]
Our analysis showed that age www.impactjournals.com/oncotarget www.impactjournals.com/oncotarget distribution between LG and open gastrectomies (OG) procedures was similar (WMD -0.22 95% confidence interval (CI), -1.26−0.82; P = 0.67; Figure 3)
We reviewed the data from nine studies to estimate the feasibility of LG for the elderly gastric cancer patients
Summary
A recent multicenter randomized and controlled trial by Hu et al demonstrated that laparoscopic gastrectomy (LG) with D2 lymph node dissection was more feasible than the conventional open distal gastrectomy for www.impactjournals.com/oncotarget advanced gastric cancer patients [1]. In our previous meta-analysis, we demonstrated that minimal invasive surgery, laparoscopic and robotic surgeries were all technically more feasible than open resections for gastric cancer because of their affirmative role in both subtotal and total gastrectomies [2]. The feasibility of LG for elderly patients needs to be established since their numbers are rapidly increasing [3,4,5]. Elderly patients are at a high risk for major surgeries because functional reserves decrease with age. Systemic stress and inflammatory responses contribute to a higher risk of delirium for elderly patients, especially after surgery. Issues like prolonged operation time and the impact of carbon dioxide pneumoperitoneum on circulatory and respiratory dynamics during LG procedure have not been evaluated [6,7,8]
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