Comparison of Postoperative Outcomes of Laparoscopic Versus Open Gastrectomy in Older Patients With Gastric Cancer

Background/Aim: Several studies have investigated the safety of laparoscopic gastrectomy (LG) for gastric cancer (GC). However, many of these studies excluded older patients, and few multicenter studies have compared LG and open gastrectomy (OG) in older patients with GC. We compared the postoperative short- and long-term outcomes of LG and OG in >75 years old patients with GC in a multicenter study.

Patients and Methods: The study included 926 patients aged >75 years who underwent gastrectomy from January 2003 to December 2017 at 12 regional hospitals. After propensity score-matching (PSM), the two surgical groups’ short- and long-term outcomes were analyzed. PSM was applied for variables such as sex, depth of tumor invasion, lymph node metastasis, histologic type, pathological stage, gastrectomy, and lymph node dissection.

Results: After 1:1 matching, 258 cases in each group were analyzed. The LG group showed significantly longer surgery times and reduced blood loss (p<0.001). There were no significant differences in the incidence of postoperative complications graded Clavien–Dindo ≥ II between the groups (23.6% vs. 19.4%, p=0.239). However, the LG group had lower and higher incidences of pneumonia (1.9% vs. 5.4%, p=0.035) and pancreatic fistula (PF; 4.7% vs. 0.04%, p=0.003), respectively. The two groups had no significant overall and disease-specific survival differences across all stages.

Conclusion: In patients aged >75 years with GC, LG can be a viable approach with careful clinical management for the risk of PF, without compromising long-term survival.