Published online Sep 27, 2022. doi: 10.4240/wjgs.v14.i9.950
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
The outstanding advantages of totally laparoscopic gastrectomy (TLG) over laparoscopic assisted gastrectomy (LAG) has been proved in many studies.
The safety and reliability of TLG for elderly patients with gastric cancer (GC) remain unclear.
To evaluate the short-term efficiency and quality of life (QOL) of TLG for elderly patients with GC.
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.
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.
TLG is safe and feasible for elderly GC patients, especially in reducing surgical bleeding, promoting postoperative recovery and improving QOL.
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.