Elderly patients aged 80 years or older accounted for up to 10% of patients who underwent gastrectomy.Citation1 In their paper “Laparoscopic distal gastrectomy is feasible in very elderly patients as compared with open distal gastrectomy,” authors conducted the retrospective comparative study of laparoscopic distal gastrectomy (LDG) versus open distal gastrectomy (ODG) to clarify the feasibility of LDG in very elderly patients (≥80 years)Citation2. The previous RCTs for early gastric cancer showed less postoperative complications only in patients with 80 years of age or youngerCitation3,4. This study is meaningful due to focus on very elderly patients who had compromised cardiopulmonary function as compared with younger patients. The results of their study showed the operating time was significantly longer in the LDG group than in the ODG group as well as previous reportsCitation2–4. Despite carbon dioxide pneumoperitoneum seemed not to led no severe morbidities in the elderly patientsCitation5, considering the prolonged operation time with LDG, the most concern was the impact of LDG for postoperative complications in elderly patients. In their study, the incidence of surgical complications did not differ significantly between the two groups, although LDG tended to reduce the medical postoperative complications (18% vs. 36%, p = .09). In a Japanese RCT in patients with clinical stage I cancer and a Chinese RCT in patients with advanced cancer, postoperative medical complications did not significantly differ between the two groups in either RCT, although these RCTs excluded very elderly patientsCitation3,6. Among medical complication pneumonia is one of the main causes of death in the elderly and it is a relatively common postoperative complication. Among abdominal surgeries, gastrectomy is especially associated with postoperative pneumonia, with the highest incidence (16%–17%)Citation7.
When we perform gastrectomy for elderly patients, reduced lymphadenectomy was sometimes chose for patients with poor general condition depend on the surgeon's judgment. In their study, the impact of reduced lymphadenectomy for postoperative complication was also examined in two subgroups which underwent standard or reduced lymphadenectomy. There was no significant difference between LDG and ODG in overall, surgical, or medical complications in either subgroup.
Despite postoperative clinical pathway was one day earlier in LDG group, LDG had a significantly shorter time to flatus, time to food intake, and postoperative hospital stay. Similar results was demonstrated by several studies in non-elderly patientsCitation8–10.
LDG for elderly patients with gastric cancer can be performed safety as well as younger patients and ODG. Further, LDG may be beneficial for very elderly patients in terms of earlier recovery after operation.
DECLARATION OF INTEREST
The authors report no conflicts of interest. The authors alone are responsible for the content and writing of the paper.
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- Japanese Gastric Cancer Association. Gastric Cancer treated in 2005 in Japan. http://www.jgca.jp/.
- Inokuchi M, Tanioka T, Nakagawa M, Okuno K, Gokita K, Kojima K. Laparoscopic Distal Gastrectomy is Feasible in Very Elderly Patients as Compared with Open Distal Gastrectomy. J Invest Surg. 2017;22:1–7. doi: 10.1080/08941939.2017.1355025. [Epub ahead of print]
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- Kim W, Kim HH, Han SU, et al. Korean Laparo-endoscopic Gastrointestinal Surgery Study (KLASS) Group. Decreased morbidity of laparoscopic distal gastrectomy compared with open distal gastrectomy for stage I gastric cancer: short-term outcomes from a multicenter randomized controlled trial (KLASS-01). Ann Surg. 2016;263:28–35.
- Suzuki S, Nakamura T, Imanishi T, et al. Carbon dioxide pneumoperitoneum led to no severe morbidities for the elderly during laparoscopic-assisted distal gastrectomy. Ann Surg Oncol. 2015;22:1548–1554.
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- Adachi Y, Shiraishi N, Shiromizu A, et al. Laparoscopy-assisted Billroth I gastrectomy compared with conventional open gastrectomy. Arch Surg. 2000;135:806–810.
- Kitano S, Shiraishi N, Fujii K, et al. A randomized controlled trial comparing open vs laparoscopy-assisted distal gastrectomy for the treatment of early gastric cancer: an interim report. Surgery. 2002;131:S306–8311.
- Yano H, Monden T, Kinuta M, et al. The usefulness of laparoscopy-assisted distal gastrectomy in comparison with that of open distal gastrectomy for early gastric cancer. Gast Cancer. 2001;4:93–97.