Retrospective Study
Copyright ©The Author(s) 2022. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastrointest Surg. Sep 27, 2022; 14(9): 950-962
Published online Sep 27, 2022. doi: 10.4240/wjgs.v14.i9.950
Comparison of short-term efficacy between totally laparoscopic gastrectomy and laparoscopic assisted gastrectomy for elderly patients with gastric cancer
Rui-Yang Zhao, Hang-Hang Li, Ke-Cheng Zhang, Hao Cui, Huan Deng, Jing-Wang Gao, Bo Wei
Rui-Yang Zhao, Hang-Hang Li, Ke-Cheng Zhang, Huan Deng, Jing-Wang Gao, Bo Wei, Department of General Surgery, First Medical Center, Chinese PLA General Hospital, Beijing 100853, China
Rui-Yang Zhao, Hang-Hang Li, Huan Deng, Jing-Wang Gao, Bo Wei, Medical School of Chinese PLA, Chinese PLA General Hospital, Beijing 100853, China
Hao Cui, School of Medicine, Nankai University, Tianjin 300071, China
Author contributions: Zhao RY, Li HH and Zhang KC equally contributed to this work; Zhao RY, Li HH, Zhang KC, Cui H, Deng H and Gao JW participated in the patient information collection; Zhao RY, Li HH and Zhang KC cleaned, analyzed the data and wrote the manuscript; Zhao RY, Li HH and Wei B revised the manuscript; Wei B designed and conceived this project; All authors have read and approved the final manuscript.
Supported by National Basic Research Program of China, No. 2019YFB1311505; National Natural Science Foundation of China, No. 81773135 and No. 82073192; Natural Science Foundation of China for Youth, No. 82103593; Natural Science Foundation of Beijing for Youth, No. 7214252; and Program of Military Medicine for Youth, No. QNF19055.
Institutional review board statement: The study involving human participants was reviewed and approved by the Research Ethics Committee of Chinese PLA General Hospital.
Informed consent statement: All the patients have signed the informed consent before participating in this study.
Conflict-of-interest statement: All the authors report no relevant conflicts of interest for this article.
Data sharing statement: The original anonymous dataset is available on request from the corresponding author at weibo@301hospital.com.cn.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Bo Wei, MD, PhD, Chief Doctor, Department of General Surgery, First Medical Center, Chinese PLA General Hospital, No. 28 Fuxing Road, Beijing 100853, China. weibo@301hospital.com.cn
Received: April 19, 2022
Peer-review started: April 19, 2022
First decision: June 22, 2022
Revised: July 4, 2022
Accepted: August 18, 2022
Article in press: August 18, 2022
Published online: September 27, 2022
Processing time: 156 Days and 4.1 Hours
Abstract
BACKGROUND

Totally laparoscopic gastrectomy (TLG) entails both gastrectomy and gastrointestinal reconstruction under laparoscopy. Compared with laparoscopic assisted gastrectomy (LAG), TLG has been demonstrated in many studies to require a smaller surgical incision, result in a faster postoperative recovery and less pain and have comparable long-term efficacy, which has been a research hotspot in recent years. Whether TLG is equally safe and feasible for elderly patients remains unclear.

AIM

To compare the short-term efficacy of and quality of life (QOL) associated with TLG and LAG in elderly gastric cancer (GC) patients.

METHODS

The clinicopathological data of 462 elderly patients aged ≥ 70 years who underwent LAG or TLG (including distal gastrectomy and total gastrectomy) between January 2017 and January 2022 at the Department of General Surgery, First Medical Center, Chinese PLA General Hospital were retrospectively collected. A total of 232 patients were in the LAG group, and 230 patients were in the TLG group. Basic patient information, clinicopathological characteristics, operation information and QOL data were collected to compare efficacy.

RESULTS

Compared with those in the LAG group, intraoperative blood loss in the TLG group was significantly lower (P < 0.001), and the time to first flatus and postoperative hospitalization time were significantly shorter (both P < 0.001). The overall incidence of postoperative complications in the TLG group was significantly lower than that in the LAG group (P = 0.01). Binary logistic regression results indicated that LAG and an operation time > 220 min were independent risk factors for postoperative complications in elderly patients with GC (P < 0.05). In terms of QOL, no statistically significant differences in various preoperative indicators were found between the LAG group and the LTG group (P > 0.05). Compared with the laparoscopic-assisted total gastrectomy group, patients who received totally laparoscopic total gastrectomy had lower nausea and vomiting scores and higher satisfaction with their body image (P < 0.05). Patients who underwent laparoscopic-assisted distal gastrectomy were more satisfied with their body image than patients in the totally laparoscopic distal gastrectomy group (P < 0.05).

CONCLUSION

TLG is safe and feasible for elderly patients with GC and has outstanding advantages such as reducing intracorporeal blood loss, promoting postoperative recovery and improving QOL.

Keywords: Totally laparoscopic gastrectomy; Laparoscopic assisted gastrectomy; Gastric cancer; Elderly patients; Efficacy comparison; Quality of life

Core Tip: Compared with laparoscopic assisted gastrectomy (LAG), totally laparoscopic gastrectomy (TLG) has been demonstrated to have many advantages in previous studies. However, whether TLG is safe and feasible for elderly gastric cancer (GC) patients was unclear before our work. In this study, we compared short-term outcomes between TLG and LAG groups and assessed patients’ quality of life (QOL) before surgery and 3 mo after surgery. We found that TLG is safe and feasible for elderly patients with GC and has outstanding advantages such as reducing intracorporeal blood loss, promoting postoperative recovery and improving QOL.