Short- and Long-Term Advantages of Laparoscopic Gastrectomy for Elderly Patients with Locally Advanced Cancer
by
, , , , and
Francesco Puccetti
1,2,*,†,
Lorenzo Cinelli
1,†,
Stefano Turi
3,
Davide Socci
1,
Riccardo Rosati
1,2,‡,
Ugo Elmore
1,2,‡ and
on behalf of the OSR CCeR Collaborative Group
§ 1
Department of Gastrointestinal Surgery, IRCCS San Raffaele Scientific Institute, 20132 Milan, Italy
2
School of Medicine, Vita-Salute San Raffaele University, 20132 Milan, Italy
3
Department of Anesthesia and Intensive Care, IRCCS San Raffaele Scientific Institute, 20132 Milan, Italy
*
Author to whom correspondence should be addressed.
†
These authors contributed equally to this work and are co-first authors.
‡
These authors contributed equally to this work and are co-last authors.
§
All members are listed in Appendix A.
Cancers 2024, 16(13), 2477; https://doi.org/10.3390/cancers16132477
Submission received: 5 May 2024
/
Revised: 16 June 2024
/
Accepted: 4 July 2024
/
Published: 7 July 2024
(This article belongs to the Special Issue Preoperative Optimisation in Patients Undergoing Cancer Surgery)
Simple Summary
The aging population has led to an increase in elderly patients with locally advanced gastric cancer (LAGC) requiring in-hospital care. These patients often present with higher levels of comorbidity and frailty, due to reduced physiological reserve and functional capacity, with a major susceptibility to surgery-related complications. However, the adoption of specific ERAS guidelines on gastric cancer surgery for elderly patients has been proven safe and effective, leading to optimize hospital stay and costs with equal complication rates. Prehabilitation programs also improve pre-treatment patient function, potentially enhancing their capacity to tolerate multimodal therapy. This study explores whether elderly patients affected by LAGC following an ERAS-based protocol may benefit from laparoscopic procedures, which could reduce operative stress and possibly improve survival in frail individuals.
Abstract
Minimally invasive surgery has provided several clinical advantages in locally advanced gastric cancer (LAGC) care, although a consensus on its application criteria remains unclear. Surgery remains a careful choice in elderly patients, who frequently present with frailty, comorbidities, and other disabling diseases. This study aims to assess the possible advantages of laparoscopic gastric resections in elderly patients presenting with LAGC. This retrospective study analyzed a single-center series of elderly patients (≥75 years) undergoing curative resections for LAGC between 2015 and 2020. A comparative analysis of open versus laparoscopic approaches was conducted, focusing on postoperative complications, length of hospital stay (LOS), and long-term survival. A total of 62 patients underwent gastrectomy through an open or a laparoscopic approach (31 pts each). The study population did not show statistically significant differences in demographics, operative risk, and neoadjuvant chemotherapy. The laparoscopic group reported significantly minimized overall complications (45.2 vs. 71%, p = 0.039) and pulmonary complications (0 vs. 9.7%, p = 0.038) as well as a shorter LOS (8 vs. 12 days, p = 0.007). Lymph node harvest was equal between the groups, although long-term overall survival presented significantly better after laparoscopic gastrectomy (p = 0.048), without a relevant difference in terms of disease-free and disease-specific survivals. Laparoscopic gastrectomy proves effective in elderly LAGC patients, offering substantial short- and long-term postoperative benefits.
Keywords:
gastrectomy; gastric cancer; frailty; laparoscopy; postoperative complications
