Abstract
BackgroundGastric cancer is one of the most common malignant tumors worldwide. With the rapid aging of global population, the number of elderly patients with local advanced gastric cancer is increasing. Surgery is the essential treatment for local advanced gastric cancer. However, elderly patients are at high risk of postoperative complications due to reduced functional reserve and increased comorbidities. Laparoscopic gastrectomy may be a promising surgery approach for elderly patients but its benefits remain controversial. We therefore proposed this randomized trial to evaluate the safety and efficacy of laparoscopic versus open gastrectomy for local advanced gastric cancer in patients aged 70 and above.MethodsThe current study has a randomized, parallel controlled, single-center, open-label, superiority design with two arms. A sample of 180 local advanced gastric cancer patients aged 70 and above will be recruited in Peking University Cancer Hospital and Institute. Participants will be randomized to either receive open or laparoscopic gastrectomy. The primary outcome is surgical safety, including complication rate, reoperation rate, readmission rate, and mortality rate within 30 days after surgery. The secondary endpoints include postoperative rehabilitation status, one-year postoperative life quality, three-year overall and disease-free survival. Assessments will take place at baseline (before random assignment), at 30 days, one-year, and three-year after the surgery. The study has been approved by an ethical review board.DiscussionWe hypothesized that laparoscopic gastrectomy is superior to open gastrectomy in terms of perioperative safety for local advanced gastric cancer patients aged 70 and above. If this hypothesis is statistically proved, the rational introduction of minimally invasive surgery technique in traditional gastrectomy can help improve the surgical safety for elderly patients, reduce patient financial burden, shorten hospital stay, and improve hospital beds turnover rate. Our research data will also provide high quality clinical evidence and data support for the conduction of multicenter phase III clinical trials.Trial registrationThe study has been prospectively registered in ClinicalTrial.gov (NCT03564834).
Highlights
Gastric cancer is one of the most common malignant tumors worldwide
The primary objective is to compare the perioperative safety of laparoscopic versus open gastrectomy for local advanced gastric cancer patients aged 70 and above
Thanks to the continuous improvement of modern surgical technology and perioperative nursing standards, elderly patients can often better tolerate large operation and age is no longer the factor restricting the choice of surgical approach [18,19,20,21]
Summary
Gastric cancer is one of the most common malignant tumors worldwide. With the rapid aging of global population, the number of elderly patients with local advanced gastric cancer is increasing. Laparoscopic gastrectomy may be a promising surgery approach for elderly patients but its benefits remain controversial. We proposed this randomized trial to evaluate the safety and efficacy of laparoscopic versus open gastrectomy for local advanced gastric cancer in patients aged 70 and above. With the rapid aging of global population, the number of elderly patients with local advanced gastric cancer has been continuously increasing. Surgical safety and effectiveness has become a crucial research focus for local advanced gastric cancer among elderly patients
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