[Application of laparoscopy-assisted total gastrectomy in elderly patients ≥65 years with gastric cancer].

Objective To evaluate the safety and feasibility of laparoscopy-assisted total gastrectomy in gastric cancer patients over 65 years old. Methods Clinical, pathological and follow-up data of 188 gastric cancer patients who underwent laparoscopy-assisted total gastrectomy at Department IV of Gastrointestinal Cancer Center, Peking University Cancer Hospital, from April 2009 to December 2016 were collected for a retrospective cohort study. Inclusion criteria were as follows: ECOG performance score 0-1; preoperative gastroscopy discovered gastric masses, and pathological biopsy confirmed adenocarcinoma; distant metastases were excluded by image examination; preoperative cardiopulmonary function was normal; preoperative blood routine test, liver and renal function, and coagulation function were normal; laparoscopy-assisted total gastrectomy was performed. Exclusion criteria: intraoperative laparoscopic exploration indicated abdominal and/or pelvic peritoneal metastasis; free cancer cells in peritoneal cavity; conversion to laparotomy during laparoscopic surgery. Patients were divided by age into 2 groups, ≥ 65 years old group (59 cases) and < 65 years old group (129 cases) . The perioperative conditions and postoperative complications between two groups were compared, and the high risk factors of postoperative complications in patients over 65 years old were analyzed. Results All the patients were operated by the same operation team. The incidence of comorbidities was 44.1% (26/59) in the ≥ 65 years old group, which was significantly higher than 20.2% (26/129) in the 0.05) . Multivariate logistic regression analysis showed that preoperative comorbidities (OR=0.223, 95%CI: 0.053 to 0.944, P=0.041) was an independent risk factor for postoperative complications in patients aged ≥ 65 years old undergoing laparoscopy-assisted total gastrectomy. The median survival time was 21.3 months and the overall 5-year survival rate was 50.0%. The 5-year survival rate was 45.5% and 57.5% in patients aged ≥ 65 and < 65 years, respectively, and there was no significant difference (P=0.205) . Conclusions Laparoscopy-assisted total gastrectomy is safe and effective in the treatment of gastric cancer patients ≥ 65 years old. Age is not a contraindication of laparoscopy-assisted total gastrectomy. Key words: Stomach neoplasms; Laparoscopic assisted total gastrectomy; Complications; Prognosis