Laparoscopy-assisted radical gastrectomy with D2 lymph node dissection for gastric cancer in the elderly

Abstract

To evaluate the feasibility and efficacy of laparoscopy-assisted radical gastrectomy with D2 lymph node (LN) dissection for elderly patients with gastric cancer. From January 2007 to December 2009, 255 gastric cancer patients aged over 65 years underwent D2 LN dissection. Of these, 116 patients underwent laparoscopy-assisted radical gastrectomy (LAG group), while 139 patients underwent conventional open gastrectomy (OG group). The recovery and complication rate were compared between the two groups. Risk factors associated with postoperative complications were investigated by univariate and multivariate analyses. Compared to the OG group, the mean blood loss and number of patients who required blood transfusion were less, and the time to first flatus, the time to resume soft diet, and postoperative hospital stay were shorter in the LAG group (all P<0.01). However, the operation time and the mean number of LN retrieval were not significantly different between the two groups (both P>0.05). The postoperative morbidity in the LAG group was 15.5% (18/116), lower than that in OG group [28.1% (39/139), P<0.05]. Logistic regression analysis revealed that there were three significant factors associated with postoperative complications such as laparoscopy-assisted gastrectomy (P<0.05), operation time (P<0.01), and preoperative comorbidity (P<0.01). Operation time (P<0.05) and preoperative comorbidity (P<0.01) were independent risk factors for complication in laparoscopy-assisted radical gastrectomy of elderly patients. The mean survival time of LAG and OG were 23.0 months and 22.5 months, respectively, and the difference was not statistically significant (P>0.05). Laparoscopy-assisted radical gastrectomy with D2 LN dissection is oncologically compatible with open gastrectomy in elderly patients with gastric cancer less invasive. Operation time and preoperative comorbidity are independent risk factors for complication in laparoscopy-assisted radical gastrectomy of elderly patients.