Abstract
Although there is no agreement on a definition of elderly, commonly an age cutoff of ≥ 65 or 75 years is used. Even if robot-assisted surgery is a validated option for the elderly population, there are no specific indications for its application in the surgical treatment of gastric cancer. The aim of this study is to evaluate the safety and feasibility of robot-assisted gastrectomy and to compare the short and long-term outcomes of robot-assisted (RG) versus open gastrectomy (OG). Patients aged ≥ 70 years old undergoing surgery for gastric cancer at the Department of Surgery of San Donato Hospital in Arezzo, between September 2012 and March 2017 were enrolled. A 1:1 propensity score matching was performed according to the following variables: age, Sex, BMI, ASA score, comorbidity, T stage and type of resection performed. 43 OG were matched to 43 RG. The mean operative time was significantly longer in the RG group (273.8 vs. 193.5 min, p < 0.01). No differences were observed in terms of intraoperative blood loss, an average number of lymph nodes removed, mean hospital stay, morbidity and mortality. OG had higher rate of major complications (6.9 vs. 16.3%, OR 2.592, 95% CI 0.623–10.785, p = 0.313) and a significantly higher postoperative pain (0.95 vs. 1.24, p = 0.042). Overall survival (p = 0.263) and disease-free survival (p = 0.474) were comparable between groups. Robotic-assisted surgery for oncological gastrectomy in elderly patients is safe and effective showing non-inferiority comparing to the open technique in terms of perioperative outcomes and overall 5-year survival.
Highlights
Gastric cancer (GC) is the fifth most common cancer and the third leading cause of cancer-related death worldwide [1].Population aging continues to grow with significant implications for each national health system, in western countries, increasing the burden of resources for assistance [2, 3]
The frail elderly are less able to tolerate the stress of medical diseases, hospitalizations and immobility; as a result, surgery can be a substantial problem in this population, showing an increase of complication rates, mortality, length of hospital stay and ICU admissions [5]
Seventy-seven patients underwent an open gastrectomy while 46 patients were operated on by robotic approach
Summary
Population aging continues to grow with significant implications for each national health system, in western countries, increasing the burden of resources for assistance [2, 3]. With this trend, cancer will become a disease of the elderly. The overall 5-year survival rate of patients with gastric cancer in western countries is around 25% [4]. The frail elderly are less able to tolerate the stress of medical diseases, hospitalizations and immobility; as a result, surgery can be a substantial problem in this population, showing an increase of complication rates, mortality, length of hospital stay and ICU admissions [5]
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