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
ARTICLE HIGHLIGHTS
Research background

The outstanding advantages of totally laparoscopic gastrectomy (TLG) over laparoscopic assisted gastrectomy (LAG) has been proved in many studies.

Research motivation

The safety and reliability of TLG for elderly patients with gastric cancer (GC) remain unclear.

Research objectives

To evaluate the short-term efficiency and quality of life (QOL) of TLG for elderly patients with GC.

Research methods

The clinicopathological data of 462 elderly patients aged ≥ 70 years who underwent LAG or TLG between January 2017 and January 2022 at Department of General Surgery, First Medical Center, PLA General Hospital were retrospectively collected. We compared the perioperative outcomes between TLG and LAG groups, and used univariate and multivariate analysis to figure out the independent risk factors of LG in elderly patients. QOL data before and 3 mo after surgery were collected to evaluate whether TLG is equally safe and feasible in elderly patients.

Research results

The overall incidence of postoperative complications in the TLG group was significantly lower than that in the LAG group (16.5% vs 26.3%, P = 0.01). Furthermore, there was no significant difference in the incidence of anastomotic site-related complications or the incidence of severe complications between the TLG group and the LAG group (P = 0.599, P = 0.830). Binary logistic regression results indicated that LAG and operation time > 220 min were independent risk factors for postoperative complications in elderly patients with GC (P < 0.05). In terms of QOL, there were no statistically significant differences in various preoperative indicators between the LAG group and the LTG group (P > 0.05). Three months after surgery, patients in the TLG group were more satisfied with their body image.

Research conclusions

TLG is safe and feasible for elderly GC patients, especially in reducing surgical bleeding, promoting postoperative recovery and improving QOL.

Research perspectives

In the further study, we will refine the complete one-year follow-up of patients and conduct a multicenter collaborative prospective study to evaluate the clinical value of TLG more thoroughly for elderly patients with GC.