Journal of Gastric Cancer

  • 제15권3호
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  • Pages.176-182
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  • 2015
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  • 2093-582X(pISSN)
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  • 2093-5641(eISSN)
대한위암학회 (The Korean Gastric Cancer Association)
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Laparoscopic Total Gastrectomy in Elderly Patients (≥70 Years) with Gastric Carcinoma: A Retrospective Study

  • Jung, Hong Sung (Division of Gastroenterological Surgery, Department of Surgery, Chonnam National University Hwasun Hospital) ;
  • Park, Young Kyu (Division of Gastroenterological Surgery, Department of Surgery, Chonnam National University Hwasun Hospital) ;
  • Ryu, Seong Yeob (Division of Gastroenterological Surgery, Department of Surgery, Chonnam National University Hwasun Hospital) ;
  • Jeong, Oh (Division of Gastroenterological Surgery, Department of Surgery, Chonnam National University Hwasun Hospital)
  • 투고 : 2015.06.06
  • 심사 : 2015.09.10
  • 발행 : 2015.09.30
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초록

Purpose: To compare the surgical outcomes of laparoscopic total gastrectomy between elderly and non-elderly patients. Materials and Methods: Between 2008 and 2015, a total of 273 patients undergoing laparoscopic total gastrectomy for gastric carcinoma were divided into two age groups: elderly (${\geq}70$ years, n=71) vs. non-elderly (<70 years, n=172). Postoperative outcomes, including length of hospital stay, morbidity, and mortality were compared between the groups. Results: The elderly group showed a significantly higher rate of comorbidities and American Society of Anesthesiologists scores than those in the non-elderly group. No significant differences were found with respect to lymphadenectomy or combined organ resection between the groups. After surgery, the elderly group showed a significantly higher incidence of grade III and above complications than the non-elderly group (15.5% vs. 4.1%, P=0.003). Among the complications, anastomosis leakage was significantly more common in the elderly group (9.9% vs. 2.9%, P=0.044). Univariate and multivariate analyses showed that old age (${\geq}70$ years) was an independent risk factor (odds ratio=4.42, 95% confidence interval=1.50~13.01) for postoperative complications of grade III and above. Conclusions: Elderly patients are more vulnerable to grade III and above complications after laparoscopic total gastrectomy than non-elderly patients. Great care should be taken to prevent and monitor the development of anastomosis leakage in elderly patients after laparoscopic total gastrectomy.

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참고문헌

  1. Jung KW, Won YJ, Kong HJ, Oh CM, Cho H, Lee DH, et al. Cancer statistics in Korea: incidence, mortality, survival, and prevalence in 2012. Cancer Res Treat 2015;47:127-141. https://doi.org/10.4143/crt.2015.060
  2. Evers BM, Townsend CM Jr, Thompson JC. Organ physiology of aging. Surg Clin North Am 1994;74:23-39. https://doi.org/10.1016/S0039-6109(16)46226-2
  3. Viñuela EF, Gonen M, Brennan MF, Coit DG, Strong VE. Laparoscopic versus open distal gastrectomy for gastric cancer: a meta-analysis of randomized controlled trials and high-quality nonrandomized studies. Ann Surg 2012;255:446-456. https://doi.org/10.1097/SLA.0b013e31824682f4
  4. Kim HH, Hyung WJ, Cho GS, Kim MC, Han SU, Kim W, et al. Morbidity and mortality of laparoscopic gastrectomy versus open gastrectomy for gastric cancer: an interim report: a phase III multicenter, prospective, randomized Trial (KLASS Trial). Ann Surg 2010;251:417-420. https://doi.org/10.1097/SLA.0b013e3181cc8f6b
  5. Kunisaki C, Makino H, Takagawa R, Oshima T, Nagano Y, Ono HA, et al. Efficacy of laparoscopy-assisted distal gastrectomy for gastric cancer in the elderly. Surg Endosc 2009;23:377-383. https://doi.org/10.1007/s00464-008-9949-1
  6. Kim MG, Kim HS, Kim BS, Kwon SJ. The impact of old age on surgical outcomes of totally laparoscopic gastrectomy for gastric cancer. Surg Endosc 2013;27:3990-3997. https://doi.org/10.1007/s00464-013-3073-6
  7. Barbosa J, Carneiro S, Preto J, Sousa H, Pinho A, Maia C. Laparoscopic gastrectomy after the age of eighty: still a good choice? J Cancer Ther 2013;4:27-30.
  8. Eom BW, Kim YW, Lee SE, Ryu KW, Lee JH, Yoon HM, et al. Survival and surgical outcomes after laparoscopy-assisted total gastrectomy for gastric cancer: case-control study. Surg Endosc 2012;26:3273-3281. https://doi.org/10.1007/s00464-012-2338-9
  9. Jeong O, Ryu SY, Zhao XF, Jung MR, Kim KY, Park YK. Shortterm surgical outcomes and operative risks of laparoscopic total gastrectomy (LTG) for gastric carcinoma: experience at a large-volume center. Surg Endosc 2012;26:3418-3425. https://doi.org/10.1007/s00464-012-2356-7
  10. Bo T, Peiwu Y, Feng Q, Yongliang Z, Yan S, Yingxue H, et al. Laparoscopy-assisted vs. open total gastrectomy for advanced gastric cancer: long-term outcomes and technical aspects of a case-control study. J Gastrointest Surg 2013;17:1202-1208. https://doi.org/10.1007/s11605-013-2218-1
  11. Japanese Gastric Cancer Association. Japanese gastric cancer treatment guidelines 2010 (ver. 3). Gastric Cancer 2011;14:113-123. https://doi.org/10.1007/s10120-011-0042-4
  12. Dindo D, Demartines N, Clavien PA. Classification of surgical complications: a new proposal with evaluation in a cohort of 6336 patients and results of a survey. Ann Surg 2004;240:205-213. https://doi.org/10.1097/01.sla.0000133083.54934.ae
  13. Sobin L, Gospodarowicz M, Witteking C, eds. TNM Classification of Malignant Tumours. 7th ed. New York: Wiley, 2009.
  14. Edge SB, Byrd DR, Compton CC, Fritz AG, Greene FL, Trotti A, eds. AJCC Cancer Staging Manual. 7th ed. New York: Springer, 2010.
  15. Polanczyk CA, Marcantonio E, Goldman L, Rohde LE, Orav J, Mangione CM, et al. Impact of age on perioperative complications and length of stay in patients undergoing noncardiac surgery. Ann Intern Med 2001;134:637-643. https://doi.org/10.7326/0003-4819-134-8-200104170-00008
  16. Eguchi T, Takahashi Y, Ikarashi M, Kasahara M, Fujii M. Is extended lymph node dissection necessary for gastric cancer in elderly patients? Eur J Surg 2000;166:949-953. https://doi.org/10.1080/110241500447119
  17. Gretschel S, Estevez-Schwarz L, Hünerbein M, Schneider U, Schlag PM. Gastric cancer surgery in elderly patients. World J Surg 2006;30:1468-1474. https://doi.org/10.1007/s00268-005-0633-5
  18. Maehara Y, Oshiro T, Oiwa H, Oda S, Baba H, Akazawa K, et al. Gastric carcinoma in patients over 70 years of age. Br J Surg 1995;82:102-105. https://doi.org/10.1002/bjs.1800820134
  19. Kim MC, Kim KH, Kim HH, Jung GJ. Comparison of laparoscopy- assisted by conventional open distal gastrectomy and extraperigastric lymph node dissection in early gastric cancer. J Surg Oncol 2005;91:90-94. https://doi.org/10.1002/jso.20271
  20. Kim YW, Baik YH, Yun YH, Nam BH, Kim DH, Choi IJ, et al. Improved quality of life outcomes after laparoscopy-assisted distal gastrectomy for early gastric cancer: results of a prospective randomized clinical trial. Ann Surg 2008;248:721-727. https://doi.org/10.1097/SLA.0b013e318185e62e
  21. Hwang SH, Park do J, Jee YS, Kim MC, Kim HH, Lee HJ, et al. Actual 3-year survival after laparoscopy-assisted gastrectomy for gastric cancer. Arch Surg 2009;144:559-664; discussion 565. https://doi.org/10.1001/archsurg.2009.110
  22. Kim MG, Yook JH, Kim KC, Kim TH, Kim HS, Kim BS, et al. Influence of obesity on early surgical outcomes of laparoscopic- assisted gastrectomy in gastric cancer. Surg Laparosc Endosc Percutan Tech 2011;21:151-154. https://doi.org/10.1097/SLE.0b013e318219a57d
  23. Kim EJ, Seo KW, Yoon KY. Laparoscopy-assisted distal gastrectomy for early gastric cancer in the elderly. J Gastric Cancer 2012;12:232-236. https://doi.org/10.5230/jgc.2012.12.4.232
  24. Mohri Y, Yasuda H, Ohi M, Tanaka K, Saigusa S, Okigami M, et al. Short- and long-term outcomes of laparoscopic gastrectomy in elderly patients with gastric cancer. Surg Endosc 2015;29:1627-1635. https://doi.org/10.1007/s00464-014-3856-4
  25. Fujisaki M, Shinohara T, Hanyu N, Kawano S, Tanaka Y, Watanabe A, et al. Laparoscopic gastrectomy for gastric cancer in the elderly patients. Surg Endosc 2015. [In print].
  26. Migita K, Takayama T, Matsumoto S, Wakatsuki K, Enomoto K, Tanaka T, et al. Risk factors for esophagojejunal anastomotic leakage after elective gastrectomy for gastric cancer. J Gastrointest Surg 2012;16:1659-1665. https://doi.org/10.1007/s11605-012-1932-4

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  9. Is surgery the best treatment for elderly gastric cancer patients? vol.13, pp.11, 2015, https://doi.org/10.4240/wjgs.v13.i11.1351